There is a moment when you notice something on your arm and think:
“Where did that come from?”
A purple mark.
A yellowish patch.
Sometimes quite a spectacular bruise.
The strange thing is, you don’t remember hitting yourself.
Then a few days later another one appears.
And eventually you start wondering whether something is wrong.
This is something I have seen many times in the pharmacy, particularly among older customers.
And quite often the explanation is fairly straightforward.
But sometimes it is worth looking a little further.
Why do we bruise?
A bruise happens when small blood vessels underneath the skin are damaged and blood leaks into the surrounding tissue.
The colour changes as the body gradually breaks down and clears that blood.
That is why a bruise can start off looking red or purple and then become greenish, yellow or brown before eventually disappearing.
The older we get, the easier this can happen.
The skin becomes thinner and loses some of the cushioning that protects the small blood vessels underneath it. Easy bruising is therefore particularly common in older people. (Right Decisions)
Sometimes you genuinely have bumped your arm against a door frame or knocked your hand against the kitchen worktop.
You simply didn’t notice it at the time.
But then I look at the medicines
This is where the pharmacist in me starts asking questions.
Because some medicines deliberately make it easier for you to bleed.
Aspirin and clopidogrel are two examples.
They are antiplatelet medicines. They reduce the ability of platelets to stick together and form blood clots.
That is exactly why they are prescribed to people who need protection against dangerous blood clots.
The downside is that you can bruise more easily and bleeding can take longer to stop. (nhs.uk)
Then there are anticoagulants such as warfarin, apixaban and rivaroxaban.
They work differently from antiplatelets, but again, one of their intended effects is to reduce clot formation.
Easy bruising can therefore be a side effect. (nhs.uk)
So if someone comes into the pharmacy showing me a collection of bruises and tells me they are taking a blood-thinning medicine, I am not immediately alarmed.
There may be a perfectly logical explanation.
Don’t stop the medicine
This is important.
I’ve occasionally had someone say:
“I think I’ll stop the aspirin for a few days and see if the bruising gets better.”
No.
That is not something to do without speaking to the doctor or pharmacist.
If you have been prescribed aspirin, clopidogrel or an anticoagulant, there is normally a good reason for it.
These medicines are being used to reduce the risk of potentially serious blood clots.
The bruising may be an inconvenience, but stopping the medicine without medical advice can remove the protection it was prescribed to provide.
With clopidogrel in particular, the NHS advises that people speak to a doctor if they are concerned about bleeding rather than simply stopping treatment. (nhs.uk)
And watch what you take alongside it
This is another area where the pharmacy can prevent problems.
Someone may be taking an antiplatelet or anticoagulant and then reach for an over-the-counter painkiller.
“Ibuprofen — it’s only an everyday painkiller.”
But medicines such as ibuprofen can increase the risk of bleeding when taken with clopidogrel.
The NHS specifically advises people taking clopidogrel not to take ibuprofen or aspirin for pain relief unless a doctor has said it is OK. (nhs.uk)
This is why I always think it is worth telling your pharmacist about everything you take.
Prescription medicines.
Over-the-counter medicines.
Vitamins.
Herbal remedies.
Supplements.
“Natural” doesn’t automatically mean “won’t interact with anything”.
When should you be concerned?
This is the bit I don’t want people to ignore.
An occasional bruise after knocking yourself is usually not particularly interesting.
But if you suddenly start developing lots of bruises without knowing why, that is different.
Particularly if the bruising is accompanied by other bleeding.
Nosebleeds.
Bleeding gums.
Blood in the urine.
Blood in the stool or black stools.
Very heavy periods.
Or tiny red or purple spots appearing on the skin.
These symptoms deserve medical assessment. (nhs.uk)
Unexplained bruising can have a number of causes, including problems affecting platelets or blood clotting.
NICE guidance specifically lists unexplained bruising, bleeding and petechiae among symptoms for which an urgent full blood count may need to be considered when assessing possible blood disorders. (Nice)
That does not mean that unexplained bruising means you have leukaemia.
Most people with easy bruising will not have a serious blood disorder.
It simply means that persistent, unexplained changes should not be casually dismissed.
There are other things worth considering
Medicines aren’t the only possible explanation.
Your pharmacist or doctor may want to consider your general health, diet and whether there are other symptoms.
Some medical conditions can affect the way blood clots.
Certain medicines, including some anti-inflammatory painkillers, antidepressants and steroids, can also contribute to easy bruising. (Right Decisions)
And occasionally blood tests are needed to investigate what is happening.
A simple conversation about when the bruising started, where it occurs, what medicines you take and whether you have any other bleeding symptoms can be surprisingly helpful.
What can you do about an ordinary bruise?
Usually, not very much.
The body is remarkably good at clearing a simple bruise by itself.
If it has only just happened, a cold pack wrapped in a towel and applied for a short period can help with swelling and discomfort.
Don’t put ice directly onto the skin.
And don’t keep poking the bruise to see whether it is still there.
I’ve seen people do that.
It doesn’t make it disappear any faster.
Don’t become frightened by every purple mark
As we get older, a few unexplained-looking bruises are not unusual.
You may have knocked yourself without remembering.
Your skin may simply be more fragile than it used to be.
Or your medicines may be making bruising more noticeable.
But there is a difference between “I bruise a little more easily than I used to” and “I’m suddenly covered in bruises and I don’t know why.”
That difference matters.
So the next time you look down and discover another purple mark on your arm, don’t immediately assume the worst.
But if the bruising is new, increasing, unexplained or accompanied by other bleeding, get it checked.
And if you take medicines that affect blood clotting, speak to your pharmacist before adding another medicine or supplement.
Sometimes the most useful thing a pharmacist can tell you isn’t what to take.
It’s what not to take — and when a symptom deserves a closer look.
Until next time, look after yourself.
This article is for general health information and is not intended to replace individual medical advice.
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