Evaluation of patients admitted to the hematology outpatient clinic for spontaneous ecchymosis: Does it suggest bleeding diathesis?

Abstract

Background: Spontaneous ecchymosis is a common reason for referral to the hematology outpatient clinic. It is important to determine whether the underlying bleeding is benign or a symptom of diathesis. Methods: The sample of this retrospective study consisted of 119 patients with normal platelet counts who presented to the adult hematology outpatient clinic with spontaneous ecchymosis between September 2021 and August 2022. The site of the ecchymosis, patients’ familial and bleeding histories, and the drugs they have been using were queried. Hemogram and coagulation parameters and peripheral smear findings of the patients were recorded, and their ISTH-SSC (International Society on Thrombosis and Haemostasis Scientific and Standardization Committee) Bleeding Assessment Tool scores were calculated. Results: The median age of the patients, of whom 113 (95%) were female and 6 (5%) were male, was 30 (18-85) years. The ecchymosis was in the extremities and the trunk in 110 (92.4%) and 9 (7.6%) patients, respectively. There was no significant difference between the patients with and without bleeding history in terms of the site of spontaneous ecchymosis, the hemogram parameters and peripheral smear findings. Similarly, the patients with and without factor deficiency have not differed significantly in terms of hemogram parameters and peripheral smear findings. Patients with any factor deficiency had significantly higher ISTH-SSC Bleeding Assessment Tool scores compared to the patients without factor deficiency. Conclusion: The findings of the study revealed that the site of ecchymosis and hemogram and coagulation parameters cannot be used as markers in the general sense, except for the ISTH-SSC Bleeding Assessment Tool scores, which predicted factor deficiency. Another finding of the study worth mentioning is the fact that number of patients with ecchymosis on the trunk among the patients presenting with the complaint of ecchymosis was significantly lower than that of patients with ecchymosis on the extremities.