Bruises and dizziness

Bruises and dizziness DEFAULT

Bruising in leukaemia VS ordinary bruising

Bruising or bleeding is one of the most common symptoms associated with a blood cancer diagnosis. According to our 2018 patient survey, “Living with Leukaemia”, frequent bruising and bleeding precedes a diagnosis of leukaemia in 24% of patients.

Bruising is defined as bleeding that occurs underneath the skin, causing black, blue or purple marks to visibly appear on the skin’s surface. Most of the time there is no reason to worry about bruising as it is the body’s natural response to injury. However, because bruises from leukaemia are very similar in appearance to ordinary bruises, they can be too easily dismissed as harmless.

The manner in which you get bruises and how long they last can be a tell-tale sign of leukaemia and may be a reason for you to book an appointment with you doctor. Spotting the difference between harmless and harmful bruising may be key in diagnosing leukaemia early.

Spotting the difference

Although bruises from leukaemia are very similar to ordinary bruises, there are a few things you can look out for to help spot the difference:

  1. They occur in unusual places – In cases of leukaemia, quite often bruises will appear in places that you wouldn’t normally expect, especially; the back, legs, and hands.

For children, bruises may start to appear on the face, buttocks, ears, chest, and head.

I noticed some unexplained bruises on my right hand and lower limbs.

  1. There are lots of them – It is not unusual to have a few bruises on your body at once, especially if you are an active person. However, multiple bruises without explanation is a reason for concern.

I counted 40 bruises on my body; I just thought I bruised easily.

  1. You can’t explain why they are there – The bruises may appear without any clear reason. In other words, bruising without damage to that part of the body. They might also develop after very slight knocks that wouldn’t normally cause a bruise.

I was bruising where I didn’t remember hitting myself.

  1. They take longer than usual to disappear – Bruises may last for longer than you would expect or might continue to grow in size.

A normal bruise tends to heal after around two to four weeks. Therefore, if a bruise lasts for more than four weeks, we recommend getting it checked by your GP.

The bruises tended to sort of keep on bleeding underneath the skin.

  1. You have been experiencing excess bleeding – Since bruising is a form of bleeding (it’s just underneath the skin), unusual bleeding from other areas of the body can also be a sign of leukaemia (e.g. heavy periods, frequent nosebleeds or bleeding gums).

I was almost constantly bleeding from the mouth and the bruises were all over my body.

So what causes bruising and bleeding in leukaemia?

As with most of the symptoms of leukaemia, bruising is caused by a deficiency of healthy blood cells within the bone marrow. The bone marrow is a spongy tissue found in the centre of some of your bones. It contains stem cells which develop into all the various blood cells. In leukaemia, the bone marrow starts to produce an excess amount of abnormal or un-developed (cancerous) white blood cells. These cancerous cells eventually accumulate and “crowd out” the normal blood cells in the bone marrow, preventing them from being produced.

One blood cell type that can be crowded out by the rapidly dividing leukaemic blood cells are the platelets. Platelets are small cell fragments that flow through the blood and are responsible for causing blood to clot after you injure yourself. Therefore, if you have leukaemia, you are more likely to bruise because your body is unable to produce enough platelets to plug up your bleeding blood vessels. Healthy adults will have between 150,000 and 450,000 platelets in every microlitre of their blood; any less than this will cause bleeding. The scientific name for this is “thrombocytopenia”.

Small red spots (petechiae)

As well as medium-to-large bruises, you might notice “rashes” appearing on your skin. Small, pinhead-sized red spots on the skin (called “petechiae”) may be a sign of leukaemia. These small red spots are actually very small bruises that cluster so that they look like a rash.

I noticed an unusual rash on his torso whilst giving him a bath.

They can be purple, red or brown in colour and usually they occur on the arms, legs and stomach, but they can also be found on the inside of your mouth and around your eyes. The spots are caused by damage to very small blood vessels in the skin (called capillaries). Due to a lack of platelets, people with leukaemia cannot properly seal these damaged blood vessels so that small amounts of blood leak into the skin. Normally, petechiae is harmless and is caused by physical strains to the body. For example, hard coughing, vomiting and crying can cause petechiae to occur in the face. However, it may be that someone with leukaemia may start to notice this becoming a problem when it wasn’t before.


Finally, leukaemia can change the appearance of the skin in a completely different way. As well as leaving dark coloured bruises and rashes over the body, you may find that your skin pales elsewhere. People with leukaemia sometimes appear paler than normal because of anaemia. Because red blood cells can also be crowded out in the bone marrow, skin that is paler than a person’s usual complexion may occur due to a reduced amount of functioning red blood cells supplying the skin.


Top 9 Causes of Unexplained Bruising

Bruises are a normal response to an injury or trauma such as a fall, a cut, or bumping into something hard, like furniture. These injuries can cause blood vessels near the surface of the skin to rupture. The blood from the vessels leaks into the tissues under the skin and gets trapped there, forming a bruise.

It’s also normal to experience more bruising as you get older. Your skin becomes thinner and more delicate, so even a minor injury may cause a bruise.

In addition, taking certain medications can also make you more likely to bruise. These include NSAIDs (nonsteroidal anti-inflammatory drugs like Motrin and Aleve), anticoagulants (blood thinners), steroids, aspirin, antidepressants, antibiotics, chemotherapy, and supplements such as vitamin E and ginkgo biloba.

But if you’re getting a lot of bruises with no obvious cause, it may be a symptom of a serious medical condition, such as liver or kidney disease or even cancer. It’s very important to see your doctor right away if you’re experiencing unexplained bruising—especially if you have other symptoms like unintentional weight loss, fatigue, or a low-grade fever.

When to see a hematologist

"One important question to ask your doctor is “Do I need to see a hematologist?” A hematologist is a type of doctor who is an expert in bleeding disorders. If you have recurrent unexplained bruising without any trauma, bleeding from other areas of the body such as the nose or gastrointestinal tract, other family members who have similar symptoms, or if your blood tests show any certain abnormalities, you should see a hematologist for further evaluation." —Dr. Elizabeth Grand

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How to tell when a bruise is normal, and when it’s a warning sign

Bruising is normal and grows more common and more visible as people age. But some bruising can be a warning sign of a serious health issue, doctors caution.

More often than not, bruising comes from physical impact or injury. When small blood vessels or capillaries are damaged, the leaking blood pools under the skin to form a bruise.

As the body reabsorbs the blood, the bruise disappears.

Bruises start out blue or purple, as the blood loses oxygen, and they turn yellow or green from compounds called biliverdin and bilirubin that the body produces when it breaks down hemoglobin.

Older people bruise more easily, as aging skin becomes thinner and loses some of the protective fatty layer underneath that helps cushion blood vessels from injury.

Blood vessels also lose some elasticity over time, while skin damage from sun exposure can cause blood vessels to break easily as well.

Consider your medications

Some bruising can be traced to ordinary medications people take every day. Over-the-counter anti-inflammatories such as ibuprofen and naproxen affect the blood’s ability to congeal or coagulate.

Taking aspirin regularly — which some people do to lower the risk of heart attack or stroke — can lead to bruising as well.

Blood thinners prescribed to lower the chances of developing blood clots can cause black-and-blue marks, as can clopidogrel, a drug some seniors take to help prevent heart disease and strokes.

Steroids such as prednisone and hydrocortisone, which might be prescribed to treat allergies, asthma or eczema, thin out the skin and can lead to easy bruising.

Antidepressants also can lower the blood-platelet count, leaving fewer cells for clotting purposes.

Size up your vitamins

Certain vitamin deficiencies, such as a lack of vitamin K, can be an explanation.

A deficiency of vitamin K, found in green leafy vegetables, could indicate a more serious issue such as inflammatory bowel disease or celiac disease.

Deficiencies of vitamins B12 or C or of folic acid also can affect bruising.

Someone lacking in iron, needed to make the hemoglobin for blood to carry oxygen throughout the body, might bruise easily.

Symptoms of iron-deficiency anemia also include severe fatigue, dizziness or shortness of breath.

Taking dietary supplements like fish oil, garlic, ginkgo and vitamin E also block platelets in the blood from clotting and can lead to easy bruising.

Check with your doctor

More seriously, liver disease such as cirrhosis can trigger bruising. The liver produces factors needed for blood clotting.

“Any problems with the liver can mess with proteins necessary for clotting,” said Dr. Neha Vyas, a family medicine physician at Ohio’s Cleveland Clinic. Kidney disease, too, affects platelets and therefore clotting, she said.

Other ailments that can impair the blood’s clotting ability are chronic inflammatory diseases, such as lupus and cancers such as Hodgkin’s disease, leukemia or multiple myeloma.

“It is important to seek medical attention if significant bruising occurs, since in some cases it can reveal health issues,” said Dr. Aarthi Anand, a geriatrician and family medicine practitioner in Los Angeles.

Alcohol causes blood vessels to relax and expand, making them more prone to breaking, and heavy drinking will lead to bruising as well.

Unexplained bruises can be nothing to worry about — especially bruises on the arms and legs, since many people knock into things without remembering they’ve done it. But unexplained bruises on the abdomen, back or face are more likely to signal an underlying condition.

Another potential cause for concern is bruising that appears suddenly.

“If your symptoms arise out of the blue, as in, you never had issues before, and then suddenly you start bleeding easily, it’s important to seek medical attention,” said Dr. Tania Elliott, a clinical instructor of medicine at NYU Langone Health in New York.

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