Concerning Bruising Episodes
Thank you for your help: I am a 35-year-old woman, standing at 5 feet 1 inch and weighing 130 pounds. I maintain a regular exercise routine and generally adhere to a healthy diet. I have been diagnosed with Hashimoto's thyroiditis and uveitis, for which I take 25 mcg of Amour Thyroid daily. Both autoimmune disorders are mostly stable. Recently, my rheumatologist mentioned that my symptoms have a lupus-like quality due to positive results from my ANA and dsDNA tests, although my titer score of 1:80 is too low for a definitive lupus diagnosis. I do not present the common symptoms associated with lupus. Since January, I have developed large, unexplainable bruises on both my legs, though they do not occur concurrently. The initial bruise appeared on the back of my right thigh, followed by one on my left leg; they typically resurface approximately every 30 days without any injury to the area. The significant bruise on my right leg first emerged on January 18, while a distinctive linear bruising on my left leg became noticeable on February 21. Recently, another bruise with a similar pattern surfaced almost in the same location. In addition to bruising, I experience various other symptoms, resembling those of POTS, indicating potential autonomic dysfunction, although I am still waiting for a diagnosis. This particular symptom of unexplained bruising is quite alarming. Who should I consult to address this issue? I have already seen two neurologists, an opto-neurologist, five rheumatologists, two endocrinologists, a gastroenterologist, two ENTs, an allergist, and I have an upcoming appointment with a cardiologist on Monday. Despite extensive blood tests and imaging procedures—such as MRIs, CT scans, and ultrasounds—results have consistently returned normal. Should I consider consulting a hematologist as well?
Answers (1)
3/24/2025, 9:40:46 PM
OpenHealth AI
It sounds like you are facing a challenging situation with unexplained bruising and complex symptoms related to your existing health conditions. The fact that these bruises appear without any injury and recur periodically is understandably concerning.
Overview of Your Condition:
- Large bruises (ecchymoses) can occur for various reasons, including vascular fragility, clotting disorders, medication effects, or autoimmune processes. Given your history of autoimmune conditions, it's important to rule out any possible links between these and the bruising.
- Your current symptoms, including potential autonomic dysfunction akin to POTS, further complicate the picture and may relate to your underlying autoimmune disorders.
Next Steps:
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Consult a Hematologist: Yes, it would be wise to consult a hematologist. They can perform specialized blood tests to check for bleeding disorders, such as platelet issues or clotting factor deficiencies that may not have been previously assessed.
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Request Specific Tests: When you meet with the hematologist, discuss:
- Coagulation panels (e.g., PT, aPTT, platelet counts).
- Tests for conditions that cause easy bruising (like thrombocytopenia or von Willebrand disease).
- An evaluation for any autoimmune-related blood issues.
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Track Bruises: Maintain a diary of your bruises, noting when they appear, their size, color, and any associated symptoms. This information can provide valuable insight for your healthcare provider.
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Review Medications: Ensure that any medications you are taking, including herbal supplements, are reviewed with your healthcare providers. Some can increase bruising or affect clotting.
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Monitor Symptoms: Keep a close watch on any accompanying symptoms, such as fatigue, increased heart rate, or other signs of potential POTS. This will help in forming a complete picture of your health status for your medical team.
Reassurance and Support: I understand how unsettling it can be to have unexplained symptoms, especially when you have been diligently seeking answers. Seeking the support of a hematologist can bring you closer to understanding the potential causes of your symptoms. You’re taking proactive steps by consulting various specialists, and continuing this journey is essential for your health and peace of mind. Please take care, and feel free to reach out if you have further questions or concerns.
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