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Bleeding and Bruising: Primary Care Evaluation

This is a corrected version of the article that appeared in print.

Pamela R. Hughes, MD
Meghan N. Lewis, MD
Shalease S. Adams, DO

American Family Physician. 2024;110(5):504-514.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Easy bruising and bleeding are commonly seen in primary care. Use of a bleeding assessment tool and a comprehensive history, physical examination, and patient-provided photographs can help identify causes of abnormal bleeding and bruising. Family history can aid diagnosis of a heritable cause. Nonaccidental trauma should be considered, especially in vulnerable populations. Initial laboratory testing includes a complete blood cell count, peripheral blood smear, prothrombin time (PT), international normalized ratio, activated partial thromboplastin time (aPTT), and fibrinogen. Normal PT and aPTT results may indicate a platelet disorder. A normal PT result with a prolonged aPTT result indicates a disorder of the intrinsic coagulation pathway, and a prolonged PT result with a normal aPTT result may indicate a disorder of the extrinsic coagulation pathway. Consultation with a hematologist is recommended when initial evaluation indicates a bleeding disorder or when suspicion remains high despite a normal laboratory workup result.

PAMELA R. HUGHES, MD, FAAFP, is an associate professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Scott Air Force Base, Ill.

MEGHAN N. LEWIS, MD, is medical director of family health at Malcolm Grow Medical Clinics and Surgical Center, Joint Base Andrews, Md.; and assistant professor at the Uniformed Services University of the Health Sciences, Bethesda, Md.

SHALEASE S. ADAMS, DO, is an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Scott Air Force Base, Ill.

Address correspondence to Pamela R. Hughes, MD, FAAFP, at pamela.r.hughes4.mil@health.mil.

Author disclosure: No relevant financial relationships.

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