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Question:..." …My grandson gets bruised easily. My daughter is worried that social services may think that the child is abused. Initial examinations are fine and none in the family seems to suffer from similar condition, his doctors are looking into finding the cause of this bruising. Can you tell us a bit what causes easy bruising?."

Dr. Keti:

Bruising:Contusion: Ecchymosis
Bruising is bleeding that occurs underneath the surface of the skin. Normally, bruising is usually caused by injury. Click on this link to find more on blood and blood formation process: KidsHealth.org In the case of spontaneous bruising or bruising with minimal injury, symptoms include gums that bleed easily, persistent gum bleeding after dental procedures, and bleeding into the joints. Normally, blood coagulation or clotting, is a body mechanism that protects against excessive bleeding following an injury or trauma. Coagulation factors, platelets, and other substances work together, form fibrin, the material that clots are made of, to stop bleeding at the site of an injury. Many factors need to be considered. The following conditions may cause bruising:

I. Bleeding Disorders:

  1. Caused by Deficiencies in clotting factors, missing clotting factors, or changes in platelet function.

    a. Clotting factors deficiency leads to deeper bleeding than platelet defects. There may be bleeding into joints (hemarthroses), muscle (hematomas), and abdomen. These disorders can be inherited, may be due to an underlying disease, or may be side effects of drugs or medication.

    b. Von Willebrand's disease: People with this disease bleed more easily. Von Willebrand's disease is passed on from parent to child, affecting male and female alike. Usually, the bleeding problems are mild. In severe cases, treatment is available to facilitate normal blood clotting. Nosebleeds, bleeding from their gums, or excessive bleeding during menstruation occurs. Some may have bleeding from the intestine. Many have increased bleeding after surgery or after dental work (particularly tooth removal). Severe bleeding and spontaneous bleeding into joints usually do not occur. It is caused by deficiency or malfunction of a specific protein, called von Willebrand factor (vWf), in the blood that helps the body form blood clots. Because the blood count is usually normal, the best test is measuring the bleeding time. Also, there are tests that directly measure the amount of vWf and also check to see how well it works. Aspirin, Ibuprofen (and other similar drugs) use should be avoided. In case of this disease treatment is needed prior to dental or surgical procedures so that bleeding is not excessive. Some can be treated with a medicine called Desmopressin Acetate. Those who cannot be treated with Desmopressin may be given vWF intravenously to effect normal clotting. Prognosis is excellent. Most patients can be managed easily, once diagnosed.

    c. Hemophilia - Hemophilia A, B and C are inherited diseases. Signs and symptoms may include: many large or deep bruises, joint pain and swelling caused by internal bleeding, bleeding within muscles, blood in urine or stool, prolonged bleeding from cuts or injuries, or after surgery or tooth extraction. For more info click on this links: MayoClinic.com

    d. Chédiak-Higashi syndrome. Chédiak-Higashi syndrome (CHS) is a rare childhood autosomal recessive disorder characterized by immune deficiency, partial oculocutaneous albinism, easy bruisability and bleeding as a result of deficient platelet dense bodies, recurrent infections with neutropenia, impaired chemotaxis and bactericidal activity, and abnormal natural killer (NK) cell function.

  2. Megaloblastic Anemia is an uncommon problem in childhood most frequently associated with vitamin deficiency or gastrointestinal disease. The two most common causes of megaloblastic anemia are deficiency of vitamin B-12 (cobalamin) and deficiency of folinic acid.

  3. Immune System-Related Diseases, such as in Immune thrombocytopenic purpura (ITP) is a clinical syndrome in which a decreased number of circulating platelets (thrombocytopenia) present as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membranes (petechiae). An abnormal autoantibody, usually immunoglobulin G (IgG) with specificity for one or more platelet membrane glycoproteins, binds to circulating platelet membranes. Children may be affected at any age, but the peak incidence occurs in children aged 3-5 years

  4. Acute Myelogenous Leukemia(AML) is a group of malignant disorders characterized by the replacement of normal bone marrow with abnormal, primitive hematopoietic cells. If untreated, the disorder uniformly results in death, usually from infection or bleeding. In the recent past, children with this malignancy had an extremely poor prognosis; however, the cure rate has improved, although treatments are associated with significant morbidity and mortality.

  5. Pregnancy Associated Eclampsia: known as severe toxicity of pregnancy. See this link for more info on bleeding disorders in women:www.4woman.gov

  • Gaucher Disease is a lipid storage disease, characterized by the deposition of glucocerebroside in cells of the macrophage-monocyte system. Hematologic manifestations of Gaucher disease include cytopenia and acquired coagulopathy caused by deficiency of factor

  • Certain Medications often cause easy bruising in normal individuals. Aspirin and non-steroidal anti-inflammatory agents such as ibuprofen (Advil, Motrin) and Naprosyn are common examples. Chronic use of corticosteroid medications (such as prednisone) can also cause easy bruising, the same applies to certain types of birth control pills. Antidepressants, some asthma medications, and anticoagulant drug therapies may all cause easy bruising. Blood thinners will also cause bruising.

  • Poor Diet will promote easy bruising.
    »Vitamin C Deficiency: vitamin C is a water-soluble vitamin that has a number of biological functions:
    Vitamin C plays a major role in preventing the blood vessels from becoming leaky and is needed to make collagen, the "glue" that strengthens many parts of the body, such as muscles and blood vessels. Vitamin C also plays important roles in wound healing and as a natural antihistamine.

    »Flavonoids are a class of water-soluble plant pigments. Some of the best-known flavonoids, such as genistein in soy, and quercetin in onions and derived from sea algae and has been shown to have a potent effect on the circulatory system. While they are not considered essential nutrients, some flavonoids support health by strengthening capillaries and other connective tissue.

    »Vitamin K is essential for blood to clot. The vitamin must be absorbed in fat, so in problems with fat absorption as in gall bladder disease, celiac disease, or ulcerative colitis, one could have trouble-absorbing vitamin K. Frequent use antibiotics such as penicillin and tetracycline, also affect the absorption of vitamin K.
  • NOTE:Large and painful bruises that develop without cause, sudden, frequent, unexplained bruising, bruises that do not fade after one week, bruises that are accompanied by bleeding of the nose or gums should be always refered to and evaluated by a physician.

  • Age Relating Changes: Like many other parts of the human body, blood vessels become more fragile with age.

  • Ehlers-Danlos Syndrome: Arthrochalasis Multiplex Congenita: Cutis Hyperelastica: EDS Ehlers-Danlos Syndrome consists of several types of genetic connective tissue disorders. In general, these are due to collagen (a naturally occurring protein) abnormality. Common characteristics include fragile and/or stretchy skin, bruising, ligaments, which are prone to dislocation and subluxation, mitral valve prolapse, hernias, and poor wound healing. Chronic joint and limb pain is common even when skeletal radiographs are normal. Early degenerative arthritis, may also present problems. When bruising presents in a child it may be incorrectly attributed to non-accidental injury. The different types of the syndrome are not graded in order of severity of the condition but each is a distinct type. Severe forms of the condition may be life threatening.

  • Cushing Syndrome, a hormonal disorder caused by excess levels of either exogenously administrated glucocorticoids or endogenous overproduction of cortisol. For more info click here:www.nih.gov

  • Cirrhosis of Liver Cirrhosis has many causes. In the United States, chronic alcoholism and hepatitis C are the most common causes. In cirrhosis scar tissue replaces normal, healthy liver tissue, blocking the flow of blood through the organ and preventing it from working as it should. Access this site for more info: www.niddk.nih.gov

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