Hematomas without blow: what are the causes?

For some time now, you have noticed with concern that you have bruised spontaneously, without having taken any hits. What can be the causes of these spontaneous bruises or hematomas? What tests will your doctor order for you? Responses from Prof. Stéphane Leprêtre, hematologist at the Henri Becquerel center in Rouen, and from Dr Philippe Blanchemaison, Parisian phlebologist.


  1. Blues without blow: bruise or hematoma
  2. Blues without blow: a drop in platelets involved
  3. Blues without blow: venous insufficiency involved

Faced with spontaneous hematomas, we must already see if there is not a drop in the level of platelets in the blood. The other cause of spontaneous bruising is venous insufficiency.

Blues without blow: bruises or hematomas?

” A spontaneous bruise is a bruise that appears smoothly or after minimal trauma that should not have given rise to bruising ,” explains Prof. Stéphane Leprêtre. Not to be confused with a hematoma which is a more important hemorrhagic syndrome: ” A hematoma is a pocket in which there is blood; it can be localized, for example, at the level of certain joints “, indicates the hematologist.

If you have small, wine-red spots on your skin, it’s purpura , infiltration of blood under the skin, due to low or malfunction of platelets, blood disease, or malfunction of blood capillaries. ” If these red spots are rather localized at the level of the legs, they can be linked to a  fragility of the blood capillaries “, specifies Professor Leprêtre.

Blues without blow: a drop in platelets involved

The platelet count is abnormal

” In the event of spontaneous bruising, your doctor will prescribe a blood test to check your platelet count “, informs Prof. Leprêtre, because ” the first cause of spontaneous bruising is indeed a drop in the platelet count “.

This  thrombocytopenia  or thrombopathy (decrease in the number of platelets in the blood) can have many causes.

  • It can  be peripheral , meaning that the platelets are destroyed outside the bone marrow. ” Peripheral thrombocytopenia can be associated with an autoimmune disease or be drug-related (aspirin, non-steroidal anti-inflammatory drugs, antibiotics, etc.) “. In this second case, it is a functional disorder of the platelets which is not quantitative but qualitative.
  • The decline in platelets can also have  a central origin . In this case, the production of platelets is reduced in the bone marrow. ” All hematological diseases (leukemia, Hodgkin’s disease, sickle cell anemia, anemia … editor’s note) can give rise to central thrombocytopenia “, specifies Professor Leprêtre. 

What about the support? ” If there is thrombocytopenia or thrombopathy, this implies  a consultation in hematology or internal medicine “, informs Professor Leprêtre.

Also read: Types of back pain and exercises to relieve pain

Platelet count is normal

” If the platelet count is normal,  it could be a problem with hemostasis, ” he adds. These can be primary (related to platelets) or secondary. Always by blood test, we will look at the markers of secondary hemostasis: 

  • PT ( prothrombin level )
  • TCA ( activated partial thromboplastin time ).

” If the platelets are normal but  the PT or TCA abnormal , it may be Willebrand’s disease , hemophilia or a constitutional deficit in hemostasis factors ,” says Prof. Leprêtre. ” These disorders give more bruises, ” he says.

Blues without blow: venous insufficiency involved

” When the doctor has ruled out a platelet problem, it is necessary to consider a venous problem, another cause of spontaneous bruises “, indicates Dr. Philippe Blanchemaison.

” Many women spontaneously bruise without bumping themselves because of poor venous return,” he informs. ” The wall of the veins is then too fragile to support the weight of the blood when the woman is standing or sitting, the veins dilate, the pressure of the large veins resonates in the small vessels, which explains why the venules are more sensitive to the slightest blow “, explains the phlebologist. 

The spontaneous bruises are in this case a reflection of the  fragility of the microcirculation . They are often accompanied by: 

  • Heavy leg sensations
  • Swollen legs.

“If the veins are fragile, there may be bruises elsewhere than on the legs, for example on the hands,” he explains.

What are the treatments?

This venous insufficiency can be treated by:

  • Wearing compression stockings or tights
  • Taking venotonics .

In parallel, hygieno-dietetique rules will be recommended to you :

  • Avoid standing or sitting for a long time
  • Avoid heat sources (hot bath, sauna, exposure to the sun, etc.)
  • Engage in physical activity
  • Losing weight if you are overweight
  • Hydrate well
  • Stop smoking
  • Sleep with raised feet …

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