bruising

  I would like to know what causes bruising?  I constantly have many bruises
  on my legs, as many as 30 or so. I have been to a Doctor and have taken a few blood tests but they
  must have been negative because I haven't heard anything from him. At first I thought it may be my
  diet,but we do eat very healthy, we are vegetariens and do take supplements. I thought that maybe the reason for this
  is because I am very athletic and I push myself a little too far?
  I have been told by my husband and a few friends that recently, my eyes are a little yellow. Should I be worried?

Dear Carol,
Bruising can be caused by trauma, defects in clotting and coagulation or vasculitis (inflammation of blood vessels). There are many causes of coagulation defects. Taking large doses of aspirin or nonsteroidal anti-inflammatory drugs (such as ibuprofen [Advil or Motrin]) can cause platelet dysfunction. End stage liver disease is also associated with coagulation defects. Vitamin K deficiency will also cause bleeding and bruising because vitamin K is required for the synthesis of a series of clotting factors. Adequate dietary intake and microbiologic biosynthesis in the gut generally meet the vitamin K requirement.  Patients on broad-spectrum antibiotics can become vitamin K deficient due to altered bacterial flora of the gut. Patients on coumadin (a vitamin K antagonist) can also become deficient.  Patients with severe malabsorption  (in diseases such as inflammatory bowel disease, cystic fibrosis, celiac sprue or short bowel syndrome) can also become vitamin K depleted. Foods rich in vitamin K are green, leafy vegetables and liver. Nevertheless,  primary vitamin K deficiency is uncommon in healthy adults.
You stated that you have a number of blood tests. Most commonly the initial work-up includes a complete blood count with platelet count, prothrombin time and partial thromboplastin time. If these are normal and a clotting disorder or other hematological disorder is suspected, other tests need to be performed. Your doctor may need to send you to a hematologist (a specialist in blood disorders) for a more complete work-up. If there is concern that your eyes are yellow, your physician can order liver function tests (especially a bilirubin level) to rule out a liver or biliary problem. Yellow-orange skin color can also be seen in people who eat a lot of  "orange colored" vegetables such as carrots or in people who take high doses of beta-carotene supplements. A high carotene level will confirm this suspicion.
Good luck to you. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
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*Keywords: bruising, liver disease, vitamin K deficiency, clotting disorders

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