Bruising is bleeding that occurs underneath the surface of the skin. Normally it is usually caused by injury. In patients with bleeding disorders, however, spontaneous bruising may occur or a bruise may appear with minimal injury. Since they are formed from clotted blood, they tend to start out as dark or reddish shadowing close to the surface of the skin. As the trapped blood is broken down and absorbed by the body, it changes color -- typically to green and yellow -- because of chemical changes in the blood. Eventually the body reabsorbs the blood and the mark disappears.
   Easy bruising and frequent bleeding are characteristic manifestations of clotting and platelet disorders, they are also prominent features in some heritable disorders. If you have unusual bruising, consult with your doctor for a medical workup.
    
Natural Supplements that may cause easy bruising when used in excess and combined with blood thinning drugs:
Fish oils when used in excess
Ginkgo biloba herbal extract may thin the blood
Ginger supplement
Garlic when eaten in excess
Onions can thin the blood

Q. When taking supplements like ginger, curcumin, fish oil and Vitamin E, is it possible that combining all of these can make one's blood too thin? I take all of these because in 2002, I had a DVT in my right leg from driving all day without exiting my vehicle. There is no history of clots in my family and all is well. But I refused to take coumadin for a long time. The natural supplements are working great. I have noticed that I easily bruise on top of my hands when I bump myself. But there aren't any problems. I even jog 50 miles a week and all my blood work is excellent. But I wonder if one can "overcoagulate" with natural supplements like the above.
    A. Yes, it is possible to thin the blood too much, but generally it is difficult to thin the blood excessively to the point of medical harm by supplements alone - for instance without aspirin or coumadin - but it can happen in rare cases.

Bruising treatment, vitamin
Therapy depends on the cause. Therefore, a thorough evaluation must be made if there is frequent bruising and it is spontaneous and unexplained. Consider rutin. Bruising after surgery may be reduced by arnica.

Those who are deficient in vitamin K may benefit with supplementation. Vitamin C may be helpful in those with easy bruising if they are not ingesting enough of this vitamin. Citrus bioflavonoids found in the white pulp of oranges, lemons, and other fruits could be helpful for some individuals. More often that not, this condition is not caused by a vitamin deficiency.

Bruising easily in the elderly
As we age, bruising becomes more common. This is because the lining of blood vessels and capillaries becomes weaker, and skin becomes thin. Skin bruising is common in the elderly and can often be readily seen on forearms. Leg bruising is also common.

Bruising cause - Unexplained
Some people — especially women — are more prone than are others. Easy bruising - or a nosebleed - can be caused by a number of medical conditions including:
     Low platelet count (thrombocytopenia)
     Hemophilia (genetic disease) and the lesser known and often undiagnosed von Willebrand disease .
     Childhood immune thrombocytopenic purpura (ITP) is acute and generally seasonal in nature, suggesting that infectious or environmental agents may trigger the immune response to produce platelet-reactive autoantibodies 4 to 8 weeks following an infection. In general, the patient is well apart from the diffuse bruising and petechiae indicative of a profound thrombocytopenia. Over a period of 6 months, the thrombocytopenia resolves in approximately 85% of children, while the remaining 15% with persistent platelet consumption are designated as chronic ITP patients. The peak age of acute ITP is 2 to 5 years of age, a period when children experience the greatest frequency of viral infections.
     Leukemia
     One must also keep in mind that bruises on infants and children could be due to physical abuse.

Medications and prescription drugs
There are a number of medications that cause easy bruising, including:
Warfarin or Coumadin - The risk of bleeding and thromboembolism (blood clots) in people who use anticoagulants increases with age. Anticoagulant medications such as Coumadin (warfarin) thin the blood and help prevent clots from forming or growing larger, thereby cutting the risk of heart attack and the type of stroke caused by artery blockages. Anticoagulant treatment in elderly patients presents a major clinical dilemma. While the risk of blood clots and the subsequent need for proper anticoagulant drug therapy increases sharply with age, the bleeding and bruising risk rises as well.
Aspirin is the cheapest blood thinning drug
Clopidogrel (Plavix)
NSAIDs such as ibuprofen
Corticosteroids such as cortisol or prednisone can thin the skin and make it more likely to bruise
There is a possibility that SSRIs such as Prozac may cause easy bruising.

Ehlers-Danlos syndromes and bruising
Ehlers-Danlos syndromes comprise a wide group of connective tissue diseases sharing clinical manifestations in skin, ligaments and joints, blood vessels and internal organs. Most EDS subtypes are caused by mutations in genes encoding the fibrillar collagens type I, III and V, or in genes coding for enzymes involved in the post-translational modification of these collagens. Easy bruising is, to a variable degree, present in all subtypes of EDS, and is because of fragility of the capillaries and the perivascular connective tissues. Vascular fragility affecting medium-sized and large arteries and veins is typically observed in the vascular subtype of EDS, caused by a molecular defect in collagen type III, an important constituent of blood vessel walls and hollow organs. Extensive bruising, spontaneous arterial rupture, leading to severe internal bleeding or premature death, and rupture of hollow organs, such as the intestine or the gravid uterus are predominant features of this subtype.

Warfarin versus Plavix
A blood clot preventer sold by Bristol-Myers Squibb Corp. and Sanofi-Aventis appears to be inferior to warfarin, the most commonly used blood thinner for the prevention of stroke in patients with irregular heart rhythm. The study, which was co-sponsored by the drugmakers, and was halted early by independent safety monitors who saw an unacceptably high incidence of stroke and other heart risks in the Plavix (clopidogrel) group compared to those taking the standard oral anticoagulant, warfarin. Warfarin is most likely better than Plavix.

Excessive Bruising or Bleeding
Some heart patients are given too large a dose of blood thinner at the hospital, which can lead to excessive bleeding. The dosing errors found in 42 percent of more than 30,000 cases stemmed from factors including physicians using a "one size fits all" dosing criteria, underestimation of the importance of using the right dosage or a lack of information about a patient's weight or other indicators. The dosing errors with three classes of blood thinners -- unfractionated heparin, low-molecular-weight heparin and glycoprotein IIb/IIIa inhibitors -- most often affected patients more vulnerable to bleeding such as the elderly, women, low-weight patients, diabetics, or patients with diminished renal function. The purpose of quickly administering blood thinners, or antithrombotic therapy, is to prevent another heart attack or stroke, the report published in the Journal of the American Medical Association said. Experts recognize that most drugs must be administered within a "therapeutic window" -- too much or too little can do harm. Of the patients at 387 U.S. hospitals studied over nine months, up to 15 percent of those who received excessive doses of blood thinners had major bleeding events likely attributable to the too-large dose.

Emails
Can Coumadin cause more bruising if taken with supplements that thin the blood?
   Yes, I think that the risk for bruising could be increased by the combination of coumadin and certain supplements, for instance fish oils.

Q. I had a carotid operation for plaque and have been on Plavix 75 mg since then. i have several diabetic related symptoms for which I take various supplements such as Omega 3, Vitamin E, Garlic, etc. Is there a danger of bruising or bleeding? How do I keep taking the supplements without subjecting myself to excessive bleeding or bruising possibility?
   A. Several supplements decrease coagulation of blood, and so does Plavix. It is the responsibility of your physician who prescribes the Plavix to discuss this matter to you in order to avoid excessive bruising or bleeding.

Q. I subscribe to your online newsletter. I have a question about bruising. I had 2 DVT's in my right leg in 2002 and a pulmonary embolism. I had a Greenfield Filter put in. There isn't anything genetic involved. I got these clots from driving nonstop for 20+ hours across country. I take a number of natural supplements, many of which contribute to healthy circulation directly and indirectly: Zyflamend, Nattokinase, CoQ10, Vitamin E, R- Lipoic Acid, Activin (Grape Seed Extract), Lutein, Policasanol, Kyolic Garlic, Carlson's Fish Oil, Flax Oil, Red Yeast Rice, Cinnamon, Glucasomine Chondrotin and MSM, Acetyl-L-Carnitine and Host Defense (16 synergistic Medicinal Mushroom Blend). I haven't had any problems in the last 5 years and all my physicals have been GREAT. I'm an avid fitness person jogging 6-9 miles 3 times a week and working out at Bally's 2 times a week (I'm 57 years young). The only after-effect is bruising. I have a tendency to bruise the top of my hands easily when I bump them on something. I apply Arnica gel and they clear up quickly. But I do bruise easily now. Can combining all these supplements cause this and is it something to worry about, possibly causing one's blood to be "too thin?" I realize you can't diagnose anything. I'm only looking for your objective opinion as no one will address this for me. Thank you-and I love your supplement newsletter!
   A. It is possible that some of the supplements such as nattokinase and fish oil and perhaps others could be contributing to the bruising, but it is difficult to say since so many of them are being taken together and it makes it very complicated.

Q. I have noticed that i have been having a lot of unexplainable easy bruising in area such as my arms legs. At first I thought that I was bumping into thing and not remembering. But it is beginning to happen to often. As a child I can recall my mother saying that I bruise easy. Now that I am a adult it does not make sense. Here I am at 43 yr old this should not happen as often as it has been lately. It like I wake up and there they are the bruises. So I have taking an important step I am now concern about this and have a lot of question. I have not asked my family doctor. Because the question had not been a concern but this day it is evident that I should have some concern. I guess my question is who or where should I start?
   A. A full medical evaluation is necessary to determine your blood clotting ability. Doctors have the knowledge to order a full blood work that checks different blood clotting factors.

Since the fall of 2006 I have begun to bruise easily, especially on my forearms. Even the water from the shower causes bruising. I have been to a hematologist and the blood work looks okay. I did have 3 major surgeries from late December 2006 to March 2007 plus a colonoscopy. I only take Tylenol when absolutely necessary. Other than that I take prometrium 100mg and Premarin 1.25 mg. I am so bruised on my arms I cannot go out in public with short sleeves. I am desperate. Is there any vitamin that might help. I do not have any health problems.
   Vitamin K is one option. I have not studied the topic of easy bruising in the elderly thoroughly but I will keep an eye open for any such research.

My husband gets awful bruises everytime he hits something. He is 70 years old and has no other problems. His arms are covered with dark blue marks at all time. Would you think that Pycnogenol would help at all?
    I have not seen studies with Pycnogenol in regard to bruising prevention or blood thinning, but I suspect this supplement may thin the blood.

Found yr great site, per the person with bruising that won't 'go out in public. Tell them 'cover blend makeup' product, good 4 arms, legs, etc. special product covers uglyest bruises, not a sheer product, for faces.

Is there a topical cream or gel to strengthen the skin on hands that easily bruise and bleed from taking Plavix. Would glycerin be of any help?
   I have not studied the role of topical creams or lotions to strengthen skin health in those taking blood thinners.