New Bruising

Hello Doctor-

I have been having some episodes of bruising for about 4 months now.  In late October I noticed a huge and very painful bruise on my left calf that lasted about three weeks.  It went through the normal stages of a bruise.  At the time I was taking high doses of Motrin for back and neck pain.  Right after that healed I started noticing small dime sized bruises on my calf ( just after the above bruise healed) and on my right arm, one on my knee cap and then another on my inner right thigh.  These bruises all are pink/light red in color, round or oval shaped and go away entirely in about 4 days.  This morning I see a very small bruise on my left upper arm. These are all happening at random and spread out times. I have been panicking that I have leukemia and that these are the early signs.  I feel fine and look healthy, have a good appetite and am not losing ( but gaining) weight. I have no swollen lymph nodes. I had a CBC done and all of the results were normal.  My platelet count (280K) and WBC (7.4) were dead center and I have no anemia or low RBC count etc.  Everything else checked out according to the doctor.  He had no real explanation for the bruising.  Three months ago I had a single nosebleed ( the weather is VERY dry) and it stopped bleeding in about 5 min. I had another when I blew my nose very hard ( several weeks later) and it stopped bleeding in about 2 or 3 minutes. I cut myself several times in the last months ( doing home repair) and I heal very fast and have no adverse or prolonged bleeding.  My guns are healthy and have no bleeding there either.  I was at my dermatologist for something unrelated ( severe winter dry skin) and he said that there could be some vascular fragility.

Can you please give me your thoughts?  I also want to point out that my mother had a history of easy bruising and bleeding.  I am a 42 y/o male with a high stress job and little outlet for anything else.

Thank you.

[Kevin Pho, MD]

Other than normal platelets, there are a wide host of bleeding disorders to consider.  This can include deficiencies in the various clotting factors or platelet function to name a few.  The presence of Motrin certainly does not help and I would consider stopping this medication if the bruising continues.

General screening tests include the platelet count, bleeding time, prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT).

Specific tests include examination of the peripheral blood smear, platelet aggregation in response to ADP, epinephrine, collagen and ristocetin; platelet release assays, coagulation factor assays, and assessment of the clot solubility in urea. Tests of fibrinolysis include the measurement of fibrin split product and D-dimer levels.

I would discuss whether these tests are reasonable in your case.  A referral to a hematologist may be considered.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[kevinmd]

Bibliography:
Drews.  Approach to the patient with a bleeding diathesis.  UptoDate, 2004.