Bleeding and Bruising in Cancer Patients

Cancer patients often have problems with excessive bleeding and bruising.

Bleeding problems may appear as frequent and/or excessive nosebleeds or gum bleeds. Patients may vomit or urinate blood. There may also be blood in the patient’s stool, which appears either bright red or turns the stool sticky and tar-like. Female patients may experience vaginal spotting or bleeding.

Patients with bruising problems may form bruises that are larger and more severe than normal. They may also develop hematomas, a type of bruise that feels like a lump under the skin. Patients with low platelets will sometimes develop little red spots that cluster together like a rash over the legs, buttocks or where a blood pressure cuff or blood draw tourniquet is placed on the arm. These spots are called petechiae.

Thrombocytopenia and cancer

Bleeding and bruising problems can be caused by low blood platelet counts, known as thrombocytopenia.

Platelets play an essential role in blood clotting (or blood coagulation). Cancer patients receiving chemotherapy or radiation to the major blood-forming bones, including the pelvis and spine, are more likely to develop thrombocytopenia. Doctors treat the condition with platelet transfusions.

Coagulopathies and cancer

Bleeding and bruising problems can also be caused by a coagulopathy. Coagulopathies are a group of conditions in which the blood lacks special proteins needed for clotting, called clotting factors.

A common coagulopathy in cancer patients is vitamin K deficiency due to poor nutrition. Antibiotics or poor bowel function also contribute to vitamin K deficiency. Since the liver plays an important role in clotting factor formation, patients with liver diseases, including metastatic or primary liver cancer, are at risk of developing coagulopathies. Patients taking blood thinning or anticoagulant medications can also suffer from bleeding and bruising due to the effects of these medications on normal blood.

Coagulopathies are treated by replacing vitamin K or the clotting factors that are missing using plasma or plasma clotting concentrates. Bleeding due to most anticoagulant medications is treated with specific antidotes.

What are some cancer symptoms associated with blood?

• Lots of bruises in areas where there hasn’t been any injury
• Small red spots that form as a cluster over the lower legs and feet
• Fatigue
• Fevers
• Drenching sweats at night
• Involuntary weight loss
• Swollen glands

Can bruising indicate cancer?

Yes. Many patients with acute leukemia seek medical help because of new bruising and a petechial rash.

What cancers have bruising as a symptom?

Flat bruises (ecchymoses) and red spots (petechiae) are frequently found on patients with leukemias, lymphomas and myeloma. Lumpy bruises (hematomas) are found in patients with primary and metastatic liver cancer and cancer patients being treated with anticoagulants.

What does a cancer bruise look like?

A cancer bruise looks like an ordinary bruise. Over a period of 10 days it usually changes from reddish purple, to purple, to purplish brown to brown. It often has smooth rounded edges and is usually flat.

What does a leukemia bruise look like?

A single leukemia bruise looks like any other bruise. The difference is that leukemia bruises keep forming and spreading. They are flat and often accompanied by a cluster of small red spots on the feet and ankles.

When should I see a doctor about unexplained bruising?

Seek medical attention when bruises keep forming in new places on your body or when bruising is associated with bleeding, petechiae, fatigue, fevers, night sweats, weight loss or swollen glands. A few routine blood tests can determine if there is a problem with a low platelet count or blood clot formation.