Signs That Warrant Immediate Medical Attention
If bruising is accompanied by any of the following, seek emergency care: significant bleeding that doesn’t stop after 10–15 minutes deep muscle or joint pain and swelling infected-appearing or rapidly spreading bruise signs of anemia (pallor, rapid heart rate, fainting) …or systemic symptoms such as fever, fatigue, night sweats, weight loss If there is a history of abuse or you suspect foul play, it is ethically and legally important to involve appropriate protective services.
How Doctors Evaluate Unexplained Bruises
History
A detailed history includes onset, frequency, size, and location of bruises; any associated symptoms (bleeding gums, nosebleeds, joint pain); medication use (including supplements/herbals); personal or family history of bleeding disorders; alcohol use and liver disease; nutritional status and dietary habits; history of injuries or falls; in children, careful social context evaluation; in elderly, fall risk and home environment.
Physical Examination
The physician evaluates bruises—size, shape, color, distribution, and pattern—and looks for signs of petechiae (tiny pinpoint hemorrhages), purpura (larger non‑blanching spots), or systemic signs such as enlarged spleen or lymph nodes. Skin integrity, signs of sun damage, signs of trauma, or needle marks (in cases of intravenous drug use) are also assessed.
