What is a bruise?

A bruise, also known as a contusion in the medical world, is damage of the soft tissues (i.e. skin, muscles, tendons, etc.) of the body caused by trauma. Trauma can be minor or major depending on how the injury occurs. When soft tissues are damaged the blood vessels under the skin can break and cause leaking of red blood cells under the skin. This leakage causes a blue, purple, red or black discolouration of the skin; this is a bruise.

Why do bruises change colour?

The changes in the colour of the bruising is related to healing time. For example, a fresh new bruise from an injury will look red or purple, there may be some swelling and it most likely will be tender to the touch. As a bruise begins to heal it changes from the red, purple colour to a more blue or black colour, a couple of days after the injury. It will then progress to a green or yellow colour about 5 to 10 days after the initial trauma. And finally after 10 days, it will begin to get lighter, like a light brown colour, and eventually will fade away. The changes in colour from red to a light brown are related to the breakdown of the red blood cells that leaked out of your blood vessels, which is a repairing system of the body.

What causes bruising:

There are many reasons your child may get a bruise, the most common cause being a fall or a minor injury. Abnormal signs of bruising may be a cause of a more serious condition like bleeding disorder. Some examples are hemophilia, thrombocytopenia, Von Willebrand Disease, Ideopathic thrombocytopenia Purpura, Henoch-Schonlein Purpura, vitamin K deficiency, leukemia, side effects of a medication or child abuse. See the list of signs of abnormal bruising below.

When should I see a doctor or nurse practitioner?

Bruises heal on their own, and as a parent you will see many of these as your child grows up. However, it is important to distinguish normal bruising from bruising related to a blood disorder or another medical condition. Signs of abnormal bruising and bleeding are:

  • Bruising that lasts longer than 2 weeks
  • Bruising in infants who have not yet started to crawl or walk
  • Unexplained bruising not related to an injury
  • Family history of a bleeding disorder or easy bruising
  • Large bruises compared to the injury – like a large bruise for a small bump
  • Nose bleed that lasts longer than 15 minutes
  • Excessive bleeding after dental procedures
  • Bruising in unusual areas – like the chest, back, hands, eye, face, buttocks
  • For teenage girls, menstruation that lasts longer than 7 days

Are there any tests for bruising?

Testing for a bruise is usually not necessary, since they do resolve on their own. However, if you child has any of the above signs of abnormal bleeding then some further testing may be warranted. Your doctor or nurse practitioner may request blood work including:

  • Complete blood count
  • Peripheral blood smear
  • Prothrombin Time or Partial Thomboplastin Time
  • Bleeding time
  • Clotting factors VIII, IX and XI
  • Fibrinogen
  • Von Willebrand factor

– Dr. Christina Cesareo and Dr. G Paul Dempsey

[Feature image: Daniel Paquet]


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