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I have developed a tendency to form very extensive bruises…

Second opinion] I have...

Second opinion] I have developed a tendency to form very extensive bruises e.g. bruising from upper lateral chest around abdomen, back, down leg and even to pubic area and penis. I am an 84 year old type 2 diabetic with severe balance problems, frequent falls etc, Meniere's syndrome, for all purposes deaf without my Cochlear implant,

Doctor's Assistant: What seems to make the symptoms worse or better? Have you noticed any swelling?

Yes, lrge clot formation under bruise

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Arthritis with three joint replacements, alcohol abuse but none in over twenty years

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Answered in 3 hours by:
1/5/2018
Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,442
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Easy bruising is commonly seen as a symptom in your age group. As we age, the skin becomes thinner and loses some of the protective fatty layer which helps cushion the blood vessels from injury. Therefore, a small knock to the arm or leg can result in a substantial bruise forming.

Medications and supplements such as aspirin, anticoagulant medications and anti-platelet agents also reduce the blood’s ability to clot. Some antibiotics have also been associated with clotting problems. The bleeding from capillary damage from a knock may take longer than usual to stop which means more blood leaks out and causes a bigger bruise.

In adults taking topical and systemic corticosteroids for allergies, asthma or eczema easy bruising can occur as the skin is thinner than normal.

Thus bruising can also occur due to the age, scurvy, steroid-induced purpura, small vessel vasculitis, and purpura associated with the presence of paraproteins. Aspirin may also be responsible which can increase the bleeding time. The diagnosis is based on the investigations. Though, with the possible exception of a prolonged bleeding time, screening tests are usually normal in patients with bleeding disorders related to vascular abnormalities (ecchymoses / bruising). Taking Vitamin C or eating citrus fruits or fresh juices may help.

The investigations done are;

1) platelet count,

2) bleeding time (BT),

3) prothrombin time (PT),

4) activated partial thromboplastin time (aPTT),

5) thrombin time (TT)

6) peripheral blood smear,

7) platelet aggregation in response to ADP, epinephrine, collagen, and ristocetin;

8) platelet release assays,

9) coagulation factor assays,

10) assessment of factor XIII activity via clot solubility testing

11) Tests of fibrinolysis; measurement of fibrin split products and D-dimer levels.

Your PCP can get them done. An initial screening can be done by the first 5 or 6 tests which would give very definitive clue to the diagnosis.

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Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,442
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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