Symptoms - Bleeding and Bruising

Certain types of cancer can cause bleeding disorders. People with blood cancer may have unusual or frequent bruising and/or bleeding as a symptom of their disease.^1-3

A bruise happens when there is bleeding under the skin. It can cause black, purple, blue, or yellow markings on the skin. Bruises usually occur after trauma to that part of the body. For example, when we bang our elbow on a table, a bruise may form.¹

Bruising that is tied to blood cancer can appear for no apparent reason. These bruises may be larger than normal.¹

Sometimes bleeding is normal. Bleeding happens because of a cut or a scrape. But the bleeding that happens in people with certain forms of blood cancer is usually much heavier and takes longer to clot.¹

There are other types of abnormal bleeding linked to blood cancers. These include:^1,2

• Nosebleeds
• Heavier-than-usual periods for people who menstruate
• Tiny red spots on the skin (petechiae)
• Blood in the stool or urine

Why does blood cancer cause bleeding or bruising?

Certain types of cancer can cause unusual bleeding or bruising. These symptoms are
particularly common with various types of blood cancer.^1,3

When blood cancer cells increase, the number of healthy blood cells can decrease. There may not be enough red blood cells, white blood cells, or platelets.^2-4

Platelets are a type of blood cell. They help the blood to clot and to stop bleeding. When we cut ourselves, platelets stick together at the cut. The bleeding stops and a scab forms. It is a part of the healing process.^2-4

Sometimes, abnormal bleeding or bruising is caused by the treatment for the cancer. Chemotherapy and other treatments can increase the risk of bleeding and bruising.^1,3,5

People with blood cancer and people who are undergoing chemotherapy can develop low platelet counts (called thrombocytopenia). If a person does not have enough platelets, clots cannot form properly. Even a minor injury may bleed for longer than is normal.^1-5

Another cause of bleeding and bruising is problems with blood clotting (coagulopathy). Things that can stop the blood from clotting normally include:¹

• Liver disease
• Blood-thinning medicines
• Not enough vitamin K

When should I see a doctor about bleeding or bruising?

See a doctor if you have any unusual bleeding or bruising. It may be a symptom of cancer. If you are being treated for cancer, you should let your doctor know about any problems so that they can advise you.¹

Unusual symptoms include:^1-5

• Bleeding that does not stop or clot after a few minutes
• Bleeding from the mouth, gums, or nose
• Vomiting blood
• Blood in the urine
• Bloody stools (these may be bright red or black and tarry in appearance)
• Bruising that seems to appear from nowhere
• Unexplained bruising accompanied by fatigue, weight loss, or fever

Additional unusual bleeding for people who menstruate can include:^1-3,5

• Unusually heavy menstrual periods
• Bleeding from the vagina that is not linked to menstruation (such as at a different time in the cycle or after menopause)

Blood tests can check platelet counts and look for other problems. Your doctor can also provide advice on what to do about excessive bleeding or bruising while you are undergoing cancer treatment. In severe cases, a platelet transfusion may be needed to treat the condition.^1,3,5

Your doctor can help you understand the best way for you to manage bleeding or bruising. General tips to help prevent further injury include:^3,5

• Avoiding over-the-counter (OTC) medicines that can increase bleeding risk. Your doctor may tell you to avoid aspirin or ibuprofen.
• Taking preventive measures such as using a softer toothbrush, using an electric razor, or keeping your feet covered.
• Taking extra care if you do start to bleed. Press firmly on the area until the bleeding stops. Ice any bruises.

Remember that unusual bleeding or bruising is not always a symptom of cancer. And not all people with cancer have bleeding or bruising symptoms. Let a doctor know about anything unusual so that they can check for possible problems.⁴