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Forum Name: Hematology Topics

Question: Lower legs bruising very badly!


 Daysma - Mon Dec 19, 2005 12:59 am

I was recently in the hospital with an undiagnosed rash that turned my whole legs black and blue, at first they were concerned with flesh eating disease. I was in hospital 10 day undergoing numerous tests. Now almost 3 weeks after getting out of the hospital, my lower legs are bruising all over, with some bruising just above and around my knees. My legs hurt extremely bad, I am using 2 tyelnol #3's every 4 hours and it still feels like I have deep charley horses, for lack of a better description. My legs are also very weak, I actually fell the other day as my right thigh muscle just gave way. My doctor tells me I have myalgia, which really is just leg pain. It seems more than this to me but I don't want to become one of "those people" who rush to the ER and waste their time if this is nothing urgent. I am unable to walk long periods and stairs kill me, I am crawling up them. I work 6 days a week and can not afford anymore time off, what can be causing this?? Please help as each day there are new bruises and more pain. As a side note, while in hospital they did many blood tests and liver function was perfectly fine. I am soo frustrated now though! The doctor has prescribed the T3's as I refuse to take anything stronger and Elavil for "myalgia" ANY IDEAS WOULD BE GREATLY APPRECIATED!!!!
I have no back pain at all or hip pain, it does not hurt to sit at all in case you thought this was from my back at all, I have been asked that before.
 Dr. Tamer Fouad - Sun Jan 29, 2006 5:23 am

User avatar Dear Daysma,

I am sorry to hear about all the pain you are going through and wish you a quick recovery.

I am really in no position to evaluate your case, however, I will try to give you a few ideas.

Hemostasis is usually broken down into two stages: primary and secondary. Primary hemostasis is an immediate (minutes) but unstable response to injury. The key participants are platelets (which form the platelet plug) and the blood vessels (which cause vasoconstriction). Secondary hemostasis, in contrast is a slower process (may take several hours) but results in a definitive fibrin clot (coagulation) that serves as the scaffold for vascular repair by the endothelium.

In the process of platelet plug formation, platelets adhere to exposed matrix molecules of the basement membrane both directly and indirectly through a bridging molecule, von Willebrand's factor (vWF).

In disorders of platelet plug formation (primary hemostasis) the site of bleeding is usually superficial such as in the skin, mucous membranes (gingivae, nares, genitourinary tract). Petechiae are present and ecchymoses is usually small, superficial. Hemarthroses, muscle hematomas are rare in such cases. However, bleeding after minor cuts is more common than those with defective coagulation. Bleeding after surgery is usually immediate and mild in those with primary hemostasis abnormalities.

Lab tests used to evaluate primary hemostasis include a complete blood count (CBC) with platelet count. Bleeding time when prolonged in the presence of a normal platelet count and the absence of aspirin (or other NSAID) intake may suggest a platelet function abnormality or a von Willebrand's factor (vWF) deficiency.

in contrast, those with disorders of coagulation (secondary hemostasis) are more likely to have bleed more deeply in the soft tissues (joints, muscles). Petechiae are absent, while ecchymoses are large and palpable. Hemarthroses, muscle hematomas are more common in coagulation diseases, while bleeding after minor cuts usually indicates an abnormality in primary hemostasis. Bleeding after surgery is usually delayed and severe in coagulation disorders.

In the evaluation of secondary hemostasis (coagulation), the aPTT, PT and INR tests all estimate the time required for clot formation after activation of anticoagulated blood in the lab. They are used as a screening test for coagulation factor defects.

Factor XIII deficiency is a rare disorder but requires a specific assay (eg, clot urea stability).

From your post you say that all your blood tests have come out normal? Your platelet counts are normal? Your bleeding time is normal? Did you get a von Willebrand's disease (vWD) screen? Have you had a PT and aPTT done?

My concern is that your joint / muscle pain could be the result of a internal bleeding in the joints or muscles for example.

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