A Normal Bruise ?

Background. Recall that I had Rituxan treatments ending some 15 weeks ago. And, that I'm waiting for Promacta approval since counts have ranged between 16-30 since. My last count was 10 days ago and was 26. Also, easy bruising has been going on for a long time. Typical bruises, I've noticed, start to disappear about two weeks after a hard bump and will be gone/undetectable in three.

A really odd thing happened today. Since I haven't had a 'normal' bruise in years, here I am, asking in this forum. I bumped my arm getting out of my car today and a bruise came up soon after about the size of a quarter. The first thing that was odd is that it was yellow, not blue, dark blue, or brown. The second thing that is odd is that it is already gone. I can't believe it. Gone is less than 12 hours. Oh my.

Is this what a normal bruise does? Roughly, what kind of count does one need for this kind of thing, 50, 100?

There aren't any real rules about bruises, when they should appear or disappear. I never really paid that much attention to it. I'd say that whatever happened, it seems good. Since it was only yellow, it wasn't too bad to begin with.

My experience has been that after blood draw the bruise was persistent for atleast 2-3 weeks.

Now with Nplate bruise is gone under a week, but no noticeable change in my counts.

Blah. I thought the bruise had gone away. But after getting it in brighter light, I see that it is still there. Though it is fainter and smaller. So if it turns brown and lasts for 2 to 3 weeks, nothing will be different. Just another blanking ITP bruise.

I guess if one has normal counts a bruise never appears and thus any bruise (with either high or low counts) wouldn't be expected to disappear after a day or two...

Jay, that is my general experience with blood draws as well. Bruises last 2 to 3 weeks. Although I would note that when I had IVIG, and counts were high for a month, I recall not getting any blood draw bruising at all.

Sandi, yes, the bruise must have been very superficial to get a yellow bruise.

The worst bruise I ever had was a huge, black spontaneous bruise on my thigh. It was as big as my fist, and looked like it had fingers going down my leg. My counts were under 10 at the time and I don't remember how long it took to go away. I was never one to search my body for bruises and never really worried unless I saw one that looked like that...but I only had it that bad once.

People with normal counts bruise too, although not spontaneously. My daughter used to have a permanent bruise near her ankle because when she was practicing dance, she had to grab that spot to hold her leg up. She only had dance class once a week. I've also seen other people with large black bruises as bad as mine was because they got hurt.

If you bump yourself and bruise, I would consider that normal, especially if it's yellow. A yellow bruise without a bump is also okay. I'd worry if the bruise appears for no reason and is purple or black. Size also matters.

Hmmm, well everyone tells me it doesn't matter. I admit, I can't prove a negative though.

One possible influence comes to mind for this bruise. In preparation for a possible Promacta induced count blow out, I've been eating fish everyday the past week. I wonder if that has increased ease of bruising - at least on the margin. Got Promacta approval letter from insurance co. Saturday. Yea!

Spontaneous bruising. It's not apparent to me how that happens. How can a vessel become permeable? Seems like one would have to have more than just an absence of platelets for that to happen. Need a lack/shortage of some clotting factor too?

As I've mentioned before, I get bruises from Omega 3 vitamins, so I could see eating salmon or fish/fish oil every day could give a bruise. It causes the few platelets you have to not function well. I believe there are quite a few foods that inhibit platelet function.
Also an odd thing I've never figured out-- I don't bruise much, but I will get some spontaneous bruising when counts are in the teens and twenties. But when my counts are under 10K and way low like 1K, 2K 3K I don't have any bruises! Not much at all for symptoms. I've had counts below 5 many many times over the past 8 years and I have NEVER had a bruise at very low counts. I really think something else is kicking in to compensate- but heck if I know what it would be. Good luck, Hal with Promacta! Good question about arteries/veins leaking to cause a spontaneous bruise. Makes no sense that it would be caused only by low platelets. Mine often start with a tender bump that is just clear fluid, then the blood to create the bruise comes about 6 hrs later.

Being a naturally clumsy person I was always covered in bruises even before I got ITP. My dearly departed husband used to say to me " for heavens sake put a long sleeved shirt on people will think I've been beating you up".
The only reason I went to see my GP in the first place was due to excessive bruising following 3 gardening accidents 1 day.
As for how long they take to disappear tends to depend on my counts. Below 30 it can take weeks.
I find bruising from blood draws depends entirely on who performs the draw and am very fussy as to who I let puncture my veins. Jolly useful being a nurse as I have several colleagues to choose from. Occasionally I have to go to GP's surgery and completely avoid 1 of the phlebos as I know it will bruise whatever my counts.
An interesting article on fish oils
www.ebmconsult.com/articles/fish-oil-omega-3-fatty-acids-epa-dha-lovaza-platelet-inhibition-bleeding-risk-mechanism

Well let see. Fish oil capsules are yellow. The bruise is yellow. A connection? Seems like red blood cells cause the eventual blue color. Sounds like I need to do some investigation into spontaneous bruising.
With light surface pressure applied to the skin, did an excess supply of fish oils/acids get squeezed out or through the blood vessels walls to create a faint bruise ?

Posey, would it be fair to say that you make sure to not consume anything that interferes with platelet function?
In an unrelated note, I've been searching for those on PDSA who have a mostly steady response to TPOs. I have only found one person so far and that is 'server'. What bothers me is that server seems to have slowly lost response despite only needing 25mg of Promacta initially. Ack! Also, it seems that those that have the hardest time with stability (snowgoose) seem to always have a strong steroid response. Sounds like food and environment allergies to me. Do you have allergies?

Hal, going by your theory, as long as we don't eat or drink anything that is yellow, purple or black, we should never have a 'spontaneous bruise'.

As to whether or not all alleged spontaneous bruises are real, who knows? I know that I have bumped myself many times in life and didn't remember it. Sometimes I was in such a hurry that I didn't have time to say 'ouch'. Later when the bruise pops up, you don't remember bumping yourself. All I know is that I didn't hurt myself bad enough to have a bruise that horrible. The words 'spontaneous bruise' have been in my ITP vocabulary since I got here in 1998. I didn't make it up and it is in the literature.

Hal, I try to not consume things that interfere with platelet function, but depends on my counts. Besides Omega 3 pills, I avoid flax oil, turmeric. I don't eat too much garlic and I avoid alfalfa sprouts because they are known to stimulate the immune system. I don't take echinacia for the same reason. My hemo asked me to avoid any willow kind of herbs because aspirin comes from that family. I don't take aspirin but if I'm having pain from inflammation I do take Ibuprophen. Its is hard on platelets but if my counts are high enough, it works well for pain.

I have some allergies, cats - had bad hay fever as a kid, I have a sensitive immune system. I don't know if I'm a strong responder to steroids or not. When I took 80mg prednisone my counts only got up to 95K, that doesn't seem too high. But I'm sensitive to steroids. I can take 1mg pred and it will bump my counts up a bit.
I've posted all this before- sorry for the redundancy, but in answer to your puzzle- I am very stable on the TPOs. On both Promacta and Nplate I can easily find a dose that gets me to 50K and will stay there. No wild swings. I once lost response to 25mg Promacta- it did nothing. Following year tried 25mg again and my counts came right up. Last year I wasn't responding to 412mcg Nplate. Dose was raised a couple times to a top dose of 495mcg. This year I am responding to 412mcg again yay!~ Dose was lowered to 408mcg with a count last week of 65K. From my experience- 6 years on TPOs, a so called loss of response does not mean forever.

Just a thought-- Some ITPers on the forum have had serious problems with bleeding- nose bleeds, bad bruising, blood blisters in mouth, brain bleeds. I have never had that even with very low counts. I wonder why? What is different? If that mechanism was understood, perhaps there could be drugs developed (or dietary changes) that would help people with bleeding problems. It seems like it could be another way to approach the ITP treatment problem. Something SAFE that would protect or prevent spontaneous bleeding would be a great addition I think.

Oh! Oh no, no! Sandi is making crazy comments! Not only that, her comment had a streak of 'incredulous' in it, to the point of humor.

Ok, does it sound reasonable to think of a spontaneous bruise as a bump without any associated pain? That all bruising is the rupture of tiny capillaries? Still, it was very odd for me to have a yellow bruise. Usually they are all (shades of) blue, which eventually turn brown, and then yellow as they fade away. I've had lots of opportunity to characterize my bruising over the years, LOL. It's like, what changed? Is this bruising with a count of 30 now instead of my past normal of 12?

Posey, thanks for the detailed reply.
Something to ponder. Is it possible that the reason why you don't bruise with counts less than 10 is the same reason why you have migraines (looking through old posts)? Assuming for a moment that the migraines are tiny capillary blocks in the brain.
It is that sort of the pondering which prompted me to ask you about consuming things that interfere with platelet function. That is, would a little bit of fish during the week reduce migraines?

Your 25mg response to Promacta, and, your stable response is interesting. Now, even more interesting, is that you have allergies with the stable response. Looking through PDSA historical recounts, folks with GPIIb-IIIa platelet antibodies (most common) have a strong response to steroids - a response which then swings wildly when on steroids. Apparently the swings are do to allergies. Then, when they get on Promacta, will again have wild response swings.

How to explain you having allergies while also having a stable response? It seems to me that the reason for this, and your 25 mg Promacta response is because you have TPO antibodies, which I believe I have as well. To explain the Promacta response, think about two different ITP cases. One (1) where platelets are destroyed in the spleen - a platelet destruction problem. Another (2) where TPO is destroyed in the spleen - a platelet production problem.

Consider what happens when each of these patient types go on Promacta. In the first case a large dose is required to overcome the platelet destruction. The more the destruction, the higher the dose. In the second case there is no platelet destruction to overcome. The problem is there is no/little TPO arriving at the bone marrow to stimulate platelet production. Only a small dose of Promacta is required - merely enough to replace the missing TPO - which was destroyed in the spleen. Does all this make sense?

This gaining and losing TPO response you mention is new for me. Don't know how to explain.Though, I have to wonder if it's possible (for someone with TPO antibodies) to take a drug when one looses response which will quickly restore the response. Steroids, Danazol, an immune suppressant?

You mention about bleeds that you don't have on low counts. During my search travails I may have come across a mention of a possible explanation. It was something about granules, or bits, or platelet bits, or granules of platelets. Something like that. It had a link in the post that I did not go to. I think it was a post by Sandi, not sure. 2010-2011 time frame. Perhaps you would start having a low count bleeding problem with a few meals of fish per week, LOL

Me crazy? Haha. You're the one that said, "With light surface pressure applied to the skin, did an excess supply of fish oils/acids get squeezed out or through the blood vessels walls to create a faint bruise ?"

Yes, most people who have had spontaneous bruises have reported that they do not hurt when touched. As bad as mine was, it didn't hurt at all.

'Sandi' is the name of a real person. 'Hal9000' is the name of a fictional character. Sandi is an icon with a reputation to uphold. Hal9000 spews crazy notions with reckless disregard. When Sandi makes crazy comments, it's like, where did reality go? Will worried parents get misguided comments about how to take care of a ITP stricken child?

Whatever you do, don't tell me that spontaneous thigh bruise is because of a spontaneous encounter while dreaming.

Ok then, Mr. Fictional Character, are you saying that there is no such thing as a spontaneous bruise?

Bwwwhahaha. Only in a spontaneous dream :laugh:

A brain bleed is a spontaneous internal bruise. Purpura is always spontaneous, that's what it is. Petechiae is also spontaneous. If you can get these smaller spontaneous bleeds then it's obvious to me that you can get bigger spontaneous bleeds.

Sandi, I was just kidding you about the dream stuff.
I now have it on good authority that a brain bleed, purpura, and petechiae are all spontaneous. Further, that these smaller spontaneous bleeds could obviously be much larger - like the bruise on your thigh.

Hopefully we are at a common understanding on 'spontaneous bruising' now

Best of platelet wishes,
F. Character

I had an understanding. Whether or not it's common depends on whether or not you agree with me.

I know you were kidding.

Sandi, was thinking about changing my 'byline'. If I changed it to 'Give me all your platelets and nobody gets hurt' would that get me booted from PDSA forum?

No, it takes a lot more than that, like harassing the moderator.

Hal, Your new by line reminded me of this.
Long before I was diagnosed with ITP I regularly donated platelets. I always had such a high count I was able to do a double or triple donation. A couple of days ago the blood center called and left a message asking me to come in and donate, they were in dire need of platelets. I started to call them and ask for my previous donations back.

Yes, I remember your original posting about having donated platelets in the past. If only it were possible to build a store. I think it is safe to say those platelets you did donate were likely *very* appreciated by some ITP / Cancer patient in the past.

Are you going to break 250 or 300 this week D Mann? :lol:

I get test results for 4.5 days on 50 mg Promacta tomorrow. I'm pumped for a good number as I smashed my leg into the side of my couch and didn't get ANY bruising at all. NONE, I was stunned. Should have been a bruise about the size of one's fist.

These TPO agonist are some exciting stuff...

Hey Sandi, did you see this?
pdsa.org/component/k2/item/1401-argx-113.html
(31 March 2017)
"We believe ARGX-113 could be a breakthrough therapy in an indication like ITP where current therapies do not adequately address symptoms or achieve remissions."

I like those words 'breakthrough therapy' :silly:

No CBC until June so I will be a full month on the Promacta.

My hema once told me that your platelets can overcompensate when they're low. She called them sticky platelets, but not to he confused with the actual medical diagnosis of sticky platelets. I was bruising more last week when my platelets were at 98k then I was when they were at 50-60k. The difference being that my platelets have been over 150k for 2 years and haven't had to compensate for anything.

Yes, when platelets are low, the ones that you do have, 'reticulated' (young, new) platelets are larger and work well. People with ITP also tend to have platelet microparticles that aid in clotting. They are too small to be counted with the analyzers.

mstrux, ok, interesting. Would you happen to know if your MPV (Mean Platelet Volume) was out of range - high, or normal, when counts were 98k?

Found this post from user 'Mark' recently regarding spontaneous bruising .
"
... My understanding of it is that little holes occur all the time in everyone in blood vessel walls. These holes get corrected and this part of the normal process of replacing the vessel wall. There is a balance or homeostasis in this tissue of normal breakdown and buildup as there is in most (all?) tissues. However, if one’s platelet numbers are too low, then some of this “normal breakdown” doesn’t get corrected and there is bleeding = spontaneous bruise, without damage inflicted from outside the body.
"
Pulling up old quotes is kind'a like pulling bs out of your as, errr ahhh I mean, pulling a rabbit out of hat. Like this:
www.youtube.com/watch?v=CUDPFtsAQk8

Edit: No not like that one - that's terrible, this one:
www.youtube.com/watch?v=q1K9EH90CyA