Lately, it seems that sustained bruises easily. Is it something I should worry about or see a doctor? I have 54 years and I enjoy excellent health.

ANSWER from Dr. William Nichols, Hematology, Mayo Clinic, Rochester, Minnesota, USA:

The bruise easily may be normal in some people and something that becomes more common with age. However, easy bruising may also signal an underlying medical problem. You should probably go where a primary care physician for evaluation, especially if the appearance of bruises is something recently raised more frequent or worse than before.

A bruise forms when broken small blood vessels, called capillaries, which lie on the surface of the skin by the force of a blow or injury. When that happens, blood leaks into the blood vessels in the skin and appears as a red spot (bright or dark), purple or black, and ultimately, the body reabsorbs the blood and the stain disappears. The most common locations for bruises are the arms and legs. Generally, the stronger the shock, the larger the bruise, but when someone bruise easily, the skin may fade much due to any small hit, even those that are barely noticeable.

Some people are just more prone to bruising, that’s no cause for concern. With the lapse of time, the tissues that attach to the capillaries begin to break and the walls of these blood vessels become more fragile and vulnerable to breaking. In addition, with age the skin becomes thinner and loses some of the fat layer that helps protect blood vessels from injury.

Notwithstanding the foregoing, the ease with which a person has bruises may also have medical importance. When suddenly begin to appear bruises, occur relatively frequently, or are singularly large or painful, it is wise to consult a doctor.

Your doctor may ask you to describe your symptoms, examine current bruising and ask about any history of bleeding in yourself and your family. Bring to appointment a list of medications you are taking because some drugs increase the risk of bruising.

An example of such drugs are blood thinners such as aspirin, warfarin and clopidogrel, which decrease the clotting ability of blood, and thus the bleeding as a result of capillary damage could last longer than normal, allowing blood to leak and form a bruise. Corticosteroids containing drugs used to treat several conditions, including allergies, asthma and eczema, may become more thin skin and easy bruising as well.

Some supplements like fish oil and ginkgo biloba can also increase bruising for its anticoagulant effect.
Depending on the outcome of the initial evaluation, your doctor may recommend blood tests to investigate the situation further, or suggest you to see your hematologist (specialist in blood disorders) for further evaluation. Another alternative is that the doctor recommends to continue monitoring the situation, without further assessment or further treatment at the moment.

The presentation of easy bruising can result from a wide range of underlying causes, including bleeding problems or blood diseases, but can be a harmless condition. It is best to see a doctor to assess the situation.

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Call your doctor immediately if you develop symptoms of anemia or if you notice a yellowish tint to your skin or the whites of the eyes.

If anemia is a hereditary disease in your family, you might want to talk to a doctor about genetic testing and genetic counseling before having children.

Forecast

The prognosis of hemolytic anemia depends on its cause and severity, as well as patient’s general health. The cases caused by medications or infections usually go away quickly. People with autoimmune hemolytic anemia usually respond well to corticosteroids or intravenous immune globulin.

In people with hereditary forms of hemolytic anemia depends on the type of inherited disease and its severity. In general, even those with more severe forms of these diseases may present a higher life expectancy than before. In some people it may be possible bone marrow transplantation.

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Inherited abnormalities in red blood cell membrane: if hemoglobin levels are normal (usually more than 10 grams per deciliter) then you may not need treatment. If hemoglobin levels fall dramatically, this may require a blood transfusion. In rare cases, the spleen is removed to decrease the destruction of red blood cells in circulation.

Hereditary enzyme deficiency in red blood cells: when serious symptoms of anemia are needed blood transfusions.

Disorders of hemoglobin: in some people with inherited disorders of hemoglobin, the disease is mild or no symptoms (such as thalassemia minor) then no treatment is necessary. People with more severe forms of thalassemia and beta thalassemia major, requires repeated blood transfusions and some may be candidates for a bone marrow transplant. Depending on the severity of symptoms, sickle cell anemia may be treated with folic acid supplements, blood transfusions, antibiotics to prevent infections and a drug called hydroxyurea (Hydrea).

Physical damage to red blood cells, depending on the severity of symptoms, this could be treated with folic acid and iron supplements and sometimes blood transfusions.

Autoimmune response, autoimmune hemolytic anemia treatment depends on the cause and severity. If the drug or the infection is caused by anemia, may be sufficient to discontinue taking the drug or recover from anemia. In severe cases, treatment may include corticosteroids such as prednisone, intravenous immunoglobulin, immunosuppressive drugs such as azathioprine (Imuran), cyclophosphamide (Cytoxan, Neosar) and rituximab (Rituxan) and removal of the spleen.

Hypersplenism, the spleen is removed in cases with severe symptoms.

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The duration of hemolytic anemia depends on its cause.

In general, when hemolytic anemia is caused by a medication or infection, is a temporary problem that disappears when medication is discontinued or is infected.

When hemolytic anemia is caused by a hereditary disease, it becomes a lifelong condition.

However, the impact of this condition in the quality of life of the person and the life span can vary greatly depending on the specific type of inherited disorder and its severity.

Some people have no symptoms. Others, however, have more persistent symptoms.

Prevention

Hemolytic anemia caused by medication can be prevented by avoiding the offending medication. There is no way to prevent hereditary forms of hemolytic anemia, although it may be possible in future gene therapy. If anemia is an inherited disease in your family, you and your spouse may want to talk with a genetic counselor about genetic testing to assess the likelihood of transmitting to their children inherited anemia.

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Symptoms vary widely. In people with mild forms of hemolytic anemia such as thalassemia minor red blood cell levels may fall but not enough to cause symptoms of anemia. In these patients, the condition may be discovered only when routine tests show anemia or red blood cells are abnormally shaped.
In others, they may develop obvious symptoms of anemia, including:

- pale skin
- fatigue
- weakness
- vertigo
- dizziness
- shortness of breath
- jaundice (a yellowing of the skin and eyes)
- urine dark tea-colored

Diagnosis

The doctor will review your medical history and ask you to describe your symptoms. Other questions might include:

- Familares have close relatives with sickle cell anemia, thalassemia, pyruvate kinase deficiency, glucose-6-phosphate or other forms of inherited anemia
- What medications you take? (Include all medications taken in recent months)
- Recently had a serious infection, especially mononucleosis or pneumonia
- It has an artificial heart valve, synthetic graft blood vessels or other implants or prostheses
- They have other medical problems, especially autoimmune diseases like lupus

During the physical examination, the doctor will look for signs of anemia (fingernails and pale skin, rapid pulse and heart murmur) and liver and spleen, which can occur when there is anemia. After this examination will be blood tests to measure levels of red blood cells, control the size and shape of red blood cells, hemoglobin measure and determine the number of reticulocytes. Reticulocytes are immature red blood cells leave the bone marrow because the marrow soon released new red blood cells quickly to try to recover from anemia. Your doctor may also order tests for blood in your stool and blood tests for anemia due to iron deficiency in certain vitamins in your diet.

According to the suspected cause of hemolytic anemia, other tests may include:

- Coombs test: This test detects hemolytic anemia caused by an abnormal immune reaction.
- Levels of G6PD: This blood test detects deficiencies in this enzyme.
- Hemoglobin electrophoresis: This blood test detects abnormal hemoglobin.
- Haptoglobin: the levels of this protein in the blood are low in people with hemolytic anemia.
- Lactic acid dehydrogenase (LDH) and bilirubin: the results of blood tests are often abnormally high in people with hemolytic anemia.

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Red blood cells are cells with the shape of a disk that contain hemoglobin and carry oxygen in the blood. Under normal circumstances, red blood cells are formed in the bone marrow and released into the bloodstream, where they circulate for 110 to 120 days. Once this period, the red cells usually disappear from the blood in the spleen and liver.

In people with hemolytic anemia, red blood cells have a short lifespan. There are two main causes of this decline in life span, a problem with these red blood cells or red blood cells are normal but an abnormal process destroys them early.

There are several medical problems that can cause hemolytic anemia, including:

Inherited abnormalities in red blood cell membrane: in these genetic (inherited), abnormalities of the proteins in the cell membrane (the outer coating of red blood cells) can cause changes in cell shape. Instead of having the form of a disk, the abnormal red blood cell is shaped like tiny cups, ovals or spheres. These cells are stiffer than normal and become a target for the spleen, which identifies them as abnormal and removes them from the blood. These diseases include hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis and hereditary poikilocytosis.

Hereditary enzyme deficiency in red blood cells: enzymes are proteins that Condic chemical reactions within the cells. When enzyme levels are abnormally low in red blood cells, the cells become fragile and prone to be destroyed quickly. The two most common inherited enzyme deficiencies that cause hemolytic anemia are pyruvate kinase deficiency and glucose-6-phosphate dehydrogenase (G6PD).

Hemoglobin Disorders: In these diseases, an inherited abnormality affects hemoglobin within red blood
cells. Hemoglobin disorders including sickle cell anemia, other less common forms of hemoglobin (an inherited disease in which abnormal hemoglobin has a structure) and thalassemia (an inherited disease that affects the ability of red blood cells to produce hemoglobin).

Physical damage to red blood cells, hemolytic anemia can occur when blood cells are damaged in any of the following situations: as they move from machine to oxygenate the blood outside the body during surgery for lung and heart, when the flow of blood passes close to the prosthesis, especially artificial heart valves or if exposed to extreme heat, as in patients with extensive burns and severe.

Autoimmune response: in this way, the immune system mistakenly destroys the body’s own cells. Autoimmune hemolytic anemia can be caused by other autoimmune conditions like lupus erythematosus (SLE or lupus), certain types of infections such as hepatitis and drugs such as penicillin, and in some cases no clear cause.

Hypersplenism: in this condition, an enlarged spleen traps and hyperactive rejos blood in the blood and destroys

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In particular, Benylin’s popularity comes from its ability to provide fast acting relief including relief of nasal congestion and congestion of mucous membranes of the upper respiratory tract, sneezing, runny nose, coughing, fever, headache, muscular aches and pains. It is a truly multipurpose medicine.

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The tingling sensation is felt similar to numbing.  As soon as you are experiencing this symptom you must treat it with medication, otherwise it would be quite difficult to curb the progression of the virus.  When you apply the medication on the affected spot, there is a good chance that the sore will decrease and disappear altogether.  Even when the outbreak continues to emerge, the severity of the cold sore symptoms can be reduced and you won’t feel as much pain as usual.

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