Approach to Bruising

Differential diagnosis

• Congenital
  • Haemophilia
  • von Willebrand’s disease
  • Hereditary haemorrhagic telangiectasia
• Endocrine
  • Cushing’s syndrome
• Infection
  • Meningococcal infection
• Coagulopathy
  • Production
    • Chronic liver disease
    • Vitamin K deficiency (malabsorption)
  • Consumption
    • Acquired haemophilia
    • Disseminated intravascular coagulation
• Platelet dysfunction
  • Production disorders
    • Drug-induced (azathioprine, methotrexate etc.)
    • Primary marrow failure (e.g. secondary to malignancy)
  • Consumptive
    • Hypersplenism
    • Idiopathic thrombocytopaenic purpura
• Inflammatory
  • Cryoglobulinaemia
  • Henoch-Schonlein purpura
• Connective tissue disease
  • Marfan’s syndrome
  • Ehlers-Danlos syndrome
• Neoplastic
  • Acute leukaemia
• Drugs
  • Warfarin
  • Heparin
  • Anti-platelets
• Pregnancy
  • HELLP syndrome
• Social
  • Alcohol abuse
  • Non-accidental injury