From bruises to blood donation, menstruation to mozzies, the first season of It Can’t Hurt To Ask focuses on blood.
Do you bruise like a peach or is it rare that a knock makes a mark on you? What should you do if you feel like you’re bruising easily and should you ever be worried if you don’t bruise at all? In this episode, Dr Joshua Richmond and Dr Aarya Murali take us through how bruises happen, how to treat a bruise and what conditions can cause easy bruising.
We also bust a few bruise myths. Is a hickey a bruise? Can you become anaemic from bruising too often? And why do bruises change colour over time?
Featured in this episode
Dr Joshua Richmond
As a clinical and laboratory haematologist at Sunshine Coast Hospital and Health Service, Dr Joshua Richmond specialises in conditions that affect the blood. In this episode, Dr Richmond details what bruises are and how to treat them, as well as the kinds of conditions he sees which impact how a person bruises.
Dr Aarya Murali
Dr Aarya Murali is a haematology registrar employed through Pathology Queensland at QML Pathology. You can also listen to Dr Murali in episode one of our podcast, as she explains How Blood Works.
Episode resources
Blood disorders
In this episode, Dr Richmond discusses a number of blood disorders including haemophilia and Von Willebrand disease that can affect how people bruise. To find out more about bleeding disorders and their symptoms, visit the Health Direct and Haemophilia Foundation Australia.
Sepsis and meningococcal
Dr Murali explains that some diseases can cause marks that look like bruises on the body, including sepsis and meningococcal. It’s important to seek medical attention for these quickly, so brush up on the signs of sepsis in adults, sepsis in children and meningococcal.
Transcript
Vox pops: Should I be concerned about bruising?
Why do people on blood thinners bruise so easily?
Can frequent bruising make me anaemic?
Should I ice a bruise?
Narrator: Welcome to It Can’t Hurt To Ask, the podcast from Queensland Health exploring all your health questions, concerns and curiosities.
This season we've been exploring the topic of In My Blood. And today’s episode is all about bruises.
Hi, I’m Lauren and this episode was recorded on the lands of the Jagera and Turrbal people. We acknowledge the Traditional Custodians and pay our respects to the Elders past and present.
As always, whatever you hear in our episodes is general information. Always speak to your doctor about your individual circumstances.
Ready? Let’s get into it.
Dr Richmond: My name's Joshua Richmond. I'm a clinical and laboratory haematologist. I work on the Sunshine Coast.
Narrator: With over a decade of haematology experience under his belt, it’s fair to say Dr Richmond knows a thing or two about blood.
Clinical haematologists work to treat patients who present with blood-related concerns while laboratory haematologists focus on the diagnosis side of things. Many specialists, like Dr Richmond, do both.
That makes him the perfect person to give us the whole story on those black and blue blemishes, aka bruises.
From a young age, kids are fascinated by bruises, pretending to get “boo-boos” and needing to be patched up by make-believe doctors. They can look gnarly, come in a range of colours and textures, be flat or be accompanied by a bump or swelling.
So, what are bruises, how do they form and what purpose do they have in our bodies?
Dr Richmond: A bruise is essentially a leakage of red cells, from the small blood vessels underneath the skin. Those red cells leak into the tissue underneath the skin and that's essentially what a bruise is. Bruises can be traumatic so you can just knock yourself and cause a very small slight injury to the small vessels underneath the skin.
It can also be non-traumatic spontaneous in some patients, but by and large most bruising is quite harmless.
Narrator: That explains how blood is involved, but why the colour change?
Dr Richmond: When red cells come out of the capillaries, they have oxygen and that's makes them makes the red cells look quite red and then over a couple of days the red cells lose the oxygen and that turns the red cells quite dark. So, the bruise becomes a dark blue and or black. And then after about 5 to 10 days you'll generally notice your bruise will go quite yellow or green. And that's because the red cells are breaking down and what's actually left over is the iron in the skin. So, the iron is actually making the skin yellow.
Narrator: While turning yellow can be a warning of something more sinister going on, when it comes to bruising, Dr Richmond assured us this is just a sign that your body is healing as it should.
Dr Richmond: Overtime, the body does absorb that iron, that's just a very natural process that everyone has to go through and that's just a very healthy part of healing.
Narrator: So, the lingering yellow that rises like a flame at the end of a bruise is nothing to be concerned about. But it does bring us to a very important point - or mineral to be precise. And that’s iron.
If iron causes our bruises to turn yellow, can extensive bruising lead to deficiencies?
So bruising, in essence it's causing loss of red cells from the body and if you're losing red cells, what you're doing is you're losing iron from the blood system. If there's a lot of bruising, that can cause a loss of iron and over the time the body can't replace the amount of iron that's being lost through the diet. So, you become deficient in iron and iron deficiency in essence causes the red cells not to be produced in the right amount and also the right size. So, you become anaemic, you become tired, it becomes very gradual. Iron deficiency is very common in Australia and often it's due to, blood loss.
Narrator: So, bruising depletes your red blood cells, which can reduce iron in your system. But you need iron to replace healthy red blood cells. That feels like a vicious circle. Is there anything we can do to help pump up our iron?
Dr Richmond: I think the main thing is to know what foods are rich in iron. So red meat is one of the best forms of iron. But other sources are often found in vegetables. So, spinach, you can take those sort of foods with vitamin C to improve the absorption in conjunction with the food.
Narrator: But what happens if going full Popeye on some spinach isn’t enough? Dr Richmond says there are different forms of supplementation that can be explored.
Dr Richmond: Some people that don't have a good diet in iron, they can sometimes tolerate iron supplementation, iron supplements and they're usually given to improve the iron and iron intake. Certainly, they can be very helpful through pregnancy and also postpartum to replenish the iron stores.
Some people find it difficult to tolerate because they get quite nauseous, or they have constipation from those iron supplements. And often we may need to use an intravenous form of iron if we really are struggling to get the iron into the body through the oral option.
Narrator: If that doesn’t work however, never fear, there are other options.
Dr Richmond: Iron infusions are quite common for those patients that are struggling with getting iron in their diet or oral iron and they can't tolerate it. So, the intravenous iron’s really quick and it essentially replaces the oral option, the ID option. It works straight away and it's done through a through a cannula which goes into the vein and it can be done for people that are also post operative or preoperative to improve their chances of getting through surgery.
Narrator: Are infusions a one and done solution, though?
Dr Richmond: It can be repeated at intervals at some point. Sometimes we need to give iron intravenous sign up to every month for some patients to obviously to minimise the requirements for blood transfusion. So iron is very much a lot safer than and a lot more, a lot more cost effective than having to give blood transfusions.
Narrator: We’ve learnt about bruising and how iron gets involved, but what about things that can influence the way we bruise?
Like a sweet little peach, some people find themselves more susceptible to bruising. In one person a bump is nothing but a bump, while for others, it can result in them turning as purple as Violet Beauregard after a trip to the Wonka factory.
Why is that? The answer, generally, is quite simple, according to Dr Richmond.
Dr Richmond: The majority of patients that bruise easy, it's usually a medication and that is commonly the blood thinners. So that could be aspirin which thins the platelets, or it could be the use of warfarin which stops the vitamin K from working on the clotting factors. It could also be a blood clotting medication such as apixaban or rivaroxaban. They're medications that are used to stop the blood from clotting.
Narrator: Sadly, medication can’t take all the blame. It can also just be something that comes with age.
Dr Richmond: As you get older, the amount of the thickness of the skin becomes thin and the protective layer of what skin provides becomes less able to do so because it's thinner.
So, we do know that the bruising becomes more of a problem because of the fact that you got less skin to protect yourself.
Narrator: And we couldn’t really do an episode on bruises without talking about hickeys, could we?
A hickey, or love bite, is, essentially a bruise from broken blood vessels. It’s caused by kissing or sucking on the skin which bursts the tiny capillaries inside. They’re more likely to show up on areas of skin that are more sensitive or softer, like your neck, shoulders or chest. Because your blood vessels live closer to the top of your skin when it’s thin or sensitive, they react quicker to irritation.
Like other bruises, hickeys also make their way through a rainbow of colours. Starting off dark red, then going to a darker purple or brown as the blood under the skin dries out. In its final stages, it can look more yellowish in colour.
Hickeys can appear in just five to 10 minutes and most clear up in just a few days or week.
While bruising is normally just a reminder of a bump—or in my case, my clumsiness—is there a point where they become more of a concern or a sign of another condition?
There are a few parts to it, but yes, sometimes it can.
So, let's get the experts to break some of these down for us a bit more.
Dr Richmond: So when we bruise, what actually happens is the capillaries usually have a small hole in them and that hole is typically filled with platelets which forms like a plug. The other thing that happens is the clotting proteins in the blood actually bind with the platelets to make the clot stronger.
Narrator: So, if platelets and clotting proteins are the dynamic duo when it comes to bruising, if we’re lacking one or the other, bruising can appear worse. Like haemophilia A, an inherited condition which means you have less clotting protein in your blood. This means there’s less to bind the red cells and platelets together to stop the body from bruising.
Haemophilia A affects just one of the thirteen clotting factors which impact how your blood develops clots. Haemophilia B relates to a different factor but can lead to the same result... You guessed it, the star of the show, bruises!
While bleeding disorders like haemophilia can be very serious, it should be reassuring to know that most children or people who bruise easily likely don’t have an underlying bleeding disorder.
Dr Richmond: By and large it is it is harmless. It's not generally a serious problem, but as I said, the important things to note I guess is if it's new unexplained and or affecting joints especially with fevers after a new medication then you should probably look at getting that checked out.
Narrator: Bruising, joints and fevers? That doesn’t sound good. What are some other instances where we should seek medical advice?
Dr Richmond: I think unexplained bruising, bruising which occurs after medications, bruising with fevers, bruising around a joint, especially when the joint is very difficult to walk on.
So, if there's a new onset of bruising, and obviously if the bruising is associated with bleeding from other parts of the body. So, nose bleeds or gum bleeds.
Narrator: But what about fevers? Why are they a cause for concern?
To tell us a bit more, we’re welcoming back a friend of the podcast, Dr Aarya Murali. You may recognise her from some of the earlier episodes in the season.
Dr Murali: My name is Dr. Arya Murali. I'm one of the haematology advanced trainees in Brisbane, Queensland. I'm currently employed through Pathology Queensland, seconded at QML Pathology.
In terms of bruising and fever, you know, that's a more complex question. So, you can see it, for example, if say someone has an injury or has had a procedure, they might have a big bruise or hematoma develop and if that gets infected for example patients can have a fever in association with a bruise.
Of course, there are also sort of rarer serious conditions – meningococcal sepsis is one that comes to mind – where patients can of course have high temperatures as a result of their infection as a result of sepsis but also have bruising as a result of that. So, there are multiple systems at play and I think a big part of what we do is teasing out what's cause, what's effect, and what's the relationship between things.
Narrator: Sepsis occurs when your body is fighting an infection, including bacterial, viral or fungal, and starts to injure its own tissues and organs. While it can be serious and very dangerous, sepsis is curable if it is identified and treated quickly.
We’ve added a link to more information about the signs of sepsis in our shownotes if you’d like to learn more.
While we’ve covered a broad range of things that can cause and influence bruising, treatment is generally the same across the board. Time and rest.
Dr Richmond: By and large I think bruising is a mild illness and it can be managed with very simple measures. There's a few sort of red flags so to speak, but generally speaking it's not a harmful condition and it doesn't lead to long term damage.
So any sort of significant bruising I generally recommend obviously rest certainly after trauma rest for the few days ice can be helpful for the first couple of days you can use gentle compression which reduces the amount of bleeding and swelling, just elevating the leg or elevating the area where it's bruised. And that's often general advice which we give to all of our patients who have a minor injury.
Narrator: What determines whether we apply ice to an injury rather than heat?
Well, cold helps ease pain by numbing the affected area, and reduces swelling and inflammation.
Importantly for bruises, the cold reduces bleeding, whereas heat brings more blood to the applied area.
Given that’s what forms the bruises in the first place, we definitely don’t want that!
Dr Murali: When your blood vessels are exposed to the cold, they contract down you know to try and preserve your core body temperature. That's the body's natural response to you know coolness if you like and as a result what ice does is essentially causes the blood vessels to shrink down and when the blood vessels contract down it just prevents more blood seeping out. By preventing that you're essentially reducing the amount of swelling and reducing the amount of inflammation in that area.
Narrator: So if you’ve got a specific injury, like a stretched ligament or you’ve walked into something and it’s a bit bruised, then ice can help alleviate some pain, discomfort and swelling.
But it’s kind of like a band-aid rather than a complete fix.
Dr Murali: But if you've got bruising because of an underlying medical problem for example like low platelets or a problem with your clotting cascade then the important thing is to seek medical attention from your local medical officer because as I said ice is really just a band-aid and ultimately what will help that person or what will help you know with that bruising is treating whatever underlying medical condition might be there.
Narrator: While bruises are often not a harmful condition, if you are concerned about new or extensive bruises, or you have any bleeding, Dr Murali says you need to seek advice or guidance from your local medical officer. The same approach should be taken if you are suspicious that the bruises may have been caused deliberately or not by accident.
Dr Murali: They might have a look over you and assess you and either give you some reassurance, do some further tests or refer you to a specialist. So, my general advice to all of our patients is, if there's something you're worried about, then I think it's important to seek that medical attention and see a local medical officer who would be able determine in case is this something that we can observe or something that needs further testing.
Narrator: Before we wrap-up, I think we’ve still got enough time to answer one more curious bruise-y question.
Dr Richmond: There are a group of patients that I see as a haematologist who have the other problem where they are predisposed to spontaneous blood clots, which is a different phenomenon. That's where the body clots easier and blood clots can present with swelling and pain. They can present with some redness, but generally they don't present with significant bruising and those patients can often need to be on medications to stop their blood from clotting,
Which is the which is the other side of the equation. The body certainly a good system to manage trauma, manage bleeding, but it sometimes has issues with both excess clotting or sometimes excess bleeding, and there's a whole variety of reasons for that.
Narrator: Thank you for listening to this episode of It Can’t Hurt To Ask. We’ve learnt everything there is to know about bruises. From how they form, to reason they change colour over time and why some people are more susceptible to bruising than others.
Thank you to Dr Joshua Richmond and Dr Aarya Murali for sharing their expertise with us.
We’ve still got a couple more blood-related topics coming up this season, including antibodies and organ donation so keep an eye – or ear out for those soon.
New episodes drop every week.
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