Everything You Need To Know About Leukemia Bruises

Leukemia is a type of blood cancer that begins in the bone marrow, where the blood cells are produced. People with leukemia have many abnormal white blood cells (leukocytes) in their blood. According to the National Cancer Institute, about 1.5% of people will be diagnosed with leukemia during their lives. 

Leukemia bruises may look like large bruises or tiny dots on the skin. A person with leukemia has a high number of cancer cells, which crowd out healthy blood cells. Fewer platelets result, increasing the risk of bleeding and bruising.

Other common leukemia symptoms include fatigue, frequent infections, and bleeding. Certain types of leukemia also cause fever, night sweats, and unintentional weight loss.

What Do Leukemia Bruises Look Like?

Leukemia causes several skin symptoms, including bruises. The bruises may appear large and dark (ecchymoses) or like tiny red or purple dots (petechiae). People with lighter skin tones may have small red dots, while people with darker skin tones may have small purple dots. Petechiae may be harder to see on darker skin tones. 

People with leukemia bruise very easily. A small bump may lead to a large bruise. You may notice tiny red or purple dots on your skin without any injury or known cause. 

Petechiae are caused by broken blood vessels called capillaries. This type of bruise often occurs in body areas where blood may collect. Common areas include the feet, legs, hands, and arms. 

This photo contains medical imagery.

See Image

Causes

Leukemia causes bruises because the cancer cells outnumber healthy platelet cells in the blood. Platelets are disc-shaped blood cells that help with blood clotting. A low number of healthy platelet cells increases the risk of bleeding and bruising.

Leukemia causes the bone marrow to produce abnormal blood cells. This causes the following:

• Thrombocytopenia: Low platelets
• Anemia: Low red blood cells
• Neutropenia: Low white blood cells

Most people with leukemia experience increased bruising and bleeding. The most common types of leukemia include:

• Acute myeloid leukemia (AML): More than 20% of cells are blasts (immature and dysfunctional), and symptoms develop more quickly. AML is the most aggressive type.
• Chronic myeloid leukemia (CML): Less than 20% of cells are blasts, and symptoms develop more slowly.
• Acute lymphoblastic leukemia (ALL): B and T cells (white blood cells central to immunity) develop into blasts. ALL is the most common childhood leukemia, making up 80% of cases.
• Chronic lymphocytic leukemia (CLL): Treatment is likely not required until symptoms develop. CLL typically occurs in people 60-70 years old.

Leukemia treatments may also cause bruising. Chemotherapy and targeted therapy are cancer treatments that lower the number of platelets in the body. 

Treating Leukemia Bruises

An oncologist is a medical doctor who specializes in diagnosing and treating cancer. Your oncologist and medical team will talk with you about how to treat your leukemia bruises if needed. 

To lower the risk of bleeding, your provider will likely recommend you stop any medications that further lower your platelet count. This includes nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and Advil (ibuprofen). 

If your platelet count becomes dangerously low, your provider may recommend a platelet transfusion to replace healthy platelets in your blood. 

Normal bruises usually heal after 1-2 weeks. Leukemia bruises may last longer because the body is not able to clot the blood. Consider using an ice pack to stop bleeding.

How To Manage Leukemia Bruising

You can manage and even prevent some leukemia bruising. Try to move gently throughout your day and be mindful of avoiding injuries. Ask your provider if it is safe for you to play sports. 

Low platelets also raise the risk of serious bleeding. Take the following precautions to lower your risk of bleeding:

• Brush your teeth gently with a soft toothbrush 
• Wear shoes throughout the day
• Handle sharp objects very carefully
• Use an electric shaver instead of a razor 
• Use lotion and lip balm to prevent dry skin
• Drink water throughout the day to stay hydrated 

Other Skin Symptoms

People with leukemia may experience several skin symptoms due to a lack of healthy platelets, red blood cells, and white blood cells. 

In addition to bleeding and bruising, leukemia skin symptoms may include:

• Mouth sores: This common symptom is caused by anemia and may be an early sign of AML. Cancer treatments like chemotherapy may also cause mouth sores. 
• Color changes: People with leukemia may have dark-colored rashes or appear very pale due to anemia. People with darker skin tones may have mucous membranes that appear gray or blue.
• Bacterial and viral infections: People with leukemia lack healthy white blood cells that usually fight infection. They are at higher risk of hair follicle infections, known as folliculitis. 
• Fungal infections: People with leukemia are at an increased risk of fungal skin infections like ringworm (an itchy, circular rash). They may also experience nail infections that cause color changes and weak, brittle nails that fall off. 
• Vasculitis: Leukemia may cause small blood vessel inflammation. This often appears as purple or darker areas on the skin. 
  

When To Call Your Healthcare Provider

Low platelet levels cause bruising and bleeding. Call your healthcare provider if your bruising or bleeding worsens or does not improve, or if you notice any of the following symptoms:

• Bleeding that does not stop after a few minutes
• Vomiting blood
• Pink or red urine
• Black or bloody poop (stool)
• Heavier period (menstrual) bleeding
• Vision changes
• Dizziness
• Headaches
• Confusion
• Fatigue 
  

A Quick Review

Leukemia is a type of blood cancer that starts in the bone marrow. As leukemia grows and spreads, the cancer cells begin to replace the healthy blood cells. This leads to a reduction in platelets, the blood cells that help to clot the blood. A lack of healthy platelets raises the risk of bleeding and bruising. 

People with leukemia may experience large, dark bruises or tiny purple or red dots. These tiny dots are called petechiae and occur when small blood vessels called capillaries break. Petechiae often occur in the feet, legs, hands, and arms. 

Other common leukemia symptoms include fatigue, frequent infections, fever, night sweats, and unintentional weight loss. While most normal bruises heal after a week or two, leukemia bruises may last longer. 

Talk with your healthcare provider if you notice that you are suddenly bruising or bleeding very easily. Your provider can order a blood test to check the number of platelets in your blood.