I understand your concern.
I have gone through your pictures and noted your history. A detailed history is required to distinguish harmless bruising from that due to an underlying bleeding disorder?
I would like some additional information.
1. You have mentioned a history of trauma. Can you please provide details of the trauma as to what kind and when did it take place ?
2. Can you mention the approximate number of bruises you have at present and the time period during which they developed ?
3. Do you have any history of prolonged bleeding from invasive procedures such as dental work, surgeries or after a delivery (if you have had one) ?
4. Do you have heavy flow lasting for more than 3 days during your periods? Or any bleeding in between periods ?
5. Do you bleed more than others from minor cuts and injuries ?
6. Do you have recurrent nosebleeds, bleeding from gums or bleeding in the joints ?
7. Any history of similar bruising in the past ?
8. Please mention the list of medications you are on including prescriptions drugs, over-the-counter medications, and dietary supplements (eg, vitamin E, ginger, gingko).
9. Any history of easy bruising or bleeding among your family members ?
10. Do you have any medical condition?
Kindly reply to the above questions in the follow up.
Please also attach a high resolution(clear) image of the large, painful and recent bruise on your right thigh.
Patient replied :
Thank you for your response.
1) I was not referring to a particular tramatic event, but any physical injury - a fall, bumping into an objet, etc.
2) Approximately 20; developed within the past 48 hours
4) No - I am currently taking a combination contraceptive and have not had a period for approximately 9 months
5) I cannot recall a recent injury to provide an answer
6) I regularly have bleeding of the gums
7) I do frequently notice unexplainable contusions, generally on the extremities but occasionally in odd places (ribs, back, etc.); I have never experienced such a large amount of bruises of this size and nature (red/brown in color, moderate pain response to pressure in even what appears to be the smallest in size - approximately 5 mm)
8) propranolol, probiotic blend, psyllium fiber, fish oil, 5-HTP, vitamin E, vitamin B complex, chlordiazepoxide/amitriptyline, multivitamin/multimineral supplement, lamotrigine, melatonin, magnesium, adderall, ginko biloba, diazepam, coezyme Q10, bupropion, l-lysine, vitamin A
9) Not to my knowledge
10) chronic insomnia, bipolar disorder I, palpitations, generalized anxiety disorder, essential tremor
Thank you for your reply.
Keeping in view of all the information provided by you, an underlying bleeding disorder is unlikely.
I am of the opinion that what you have is non-significant easy bruising. Easy bruising is considered significant when there are five or more bruises greater than 1 cm in diameter which is not the case with you. In addition, apart from the bleeding gums and distribution of bruises over the trunk, there is no other positive history to indicate an underlying disorder.
Fish oil and vitamin E supplements are known increase risk for bruising. This along with the fact that you are a fair-skinned lady makes you more prone to develop bruising.
Your bleeding gums may be due to gingivitis(gum inflammation), especially if you have swollen gums and bleeding occurs on brushing. Brushing twice daily, flossing once daily, and rinsing with an antimicrobial/antiseptic mouth rinse or dentifrice (eg toothpaste, powder or gel) twice daily, if not already in practice, should be followed to prevent gingivitis.
However, in order to confirm the benign nature of your bruising, and to be on the safer side, baseline assays including a complete blood count (CBC) with differential and platelet count, prothrombin time (PT), and activated partial thromboplastin (PTT) time should be performed. You can book an appointment with your GP for the same.
You can upload the results after getting the tests done.
Let me know if I can assist you any further.