Night sweats: Some individuals experience episodes of heavy sweating during sleep.
Unexplained weight loss: Losing weight without deliberately changing eating habits or physical activity may deserve investigation.
Bone or joint discomfort: Some people experience pain associated with abnormal blood cell production in the bone marrow.
Not everyone with leukemia experiences all these symptoms. Some people may initially notice only one or two changes.
It is also important to remember that these symptoms can occur in many other illnesses.
For example, fatigue may be caused by anemia, sleep problems, infections, nutritional deficiencies, or thyroid conditions.
A fever does not automatically indicate cancer, and night sweats can have numerous explanations.
The combination, persistence, and progression of symptoms are important factors for doctors to consider.
Which bruises deserve particular attention?
Medical assessment is especially important when someone notices:
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Multiple bruises appearing without an obvious injury.
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Large bruises that seem disproportionate to minor impacts.
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Bruises appearing on the chest, stomach, back, or other unusual locations.
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Bruises that repeatedly develop over a short period.
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Unexplained bruising accompanied by nosebleeds or bleeding gums.
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Tiny red or purple spots that do not fade when pressed.
Leukaemia Care emphasizes that unexplained bruising and bleeding can be associated with leukemia, but also stresses that many people experiencing these symptoms do not have blood cancer.
The most important point is to avoid both extremes.
Ignoring repeated unexplained bruising can delay the diagnosis of a treatable condition. On the other hand, assuming that every purple mark represents cancer can create unnecessary anxiety.
A medical examination and appropriate blood tests are the correct way to investigate persistent symptoms.
Chapter 4: What Tests Can Doctors Use to Find the Real Cause?
When someone visits a doctor because of repeated unexplained bruising, the first step is usually not to assume that cancer is present.
Instead, the doctor will try to understand why the blood vessels are leaking blood beneath the skin and whether the body's clotting system is working properly.
A single purple mark may have a simple explanation. However, repeated bruising, unusual bleeding, or other symptoms may require further investigation.
1. Reviewing medical history and medications
The examination usually begins with questions about when the bruises appeared, how often they occur, and whether the person remembers any injuries.
The doctor may also ask:
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Have similar bruises appeared elsewhere?
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Do minor cuts take longer than usual to stop bleeding?
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Have you experienced frequent nosebleeds?
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Do your gums bleed when brushing your teeth?
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Have you recently started taking new medication?
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Does anyone in your family have a bleeding disorder?
These questions help identify possible patterns.
For example, someone who has recently started taking an anticoagulant may be more likely to develop bruises.
A person who has experienced frequent bleeding since childhood may need an assessment for an inherited clotting disorder.
The doctor will also ask about supplements, previous illnesses, alcohol consumption, and other relevant medical information.
2. Complete blood count
One of the most useful initial investigations is a complete blood count, commonly called a CBC.
This blood test measures several components of the blood, including:
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Red blood cells.
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White blood cells.
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Hemoglobin.
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Platelets.
The platelet count is particularly relevant when someone experiences unexplained bruising.
If the platelet level is significantly reduced, the doctor may investigate conditions affecting platelet production, destruction, or distribution.
The red and white blood cell measurements can also provide important information.
Certain abnormalities may suggest anemia, infection, or a possible bone marrow disorder.
However, a CBC alone cannot diagnose every blood condition.
Additional tests may be necessary depending on the findings.
3. Blood clotting tests
Doctors may request tests that examine how quickly blood forms clots.
Two commonly used investigations are:
Prothrombin time (PT): This measures how long blood takes to clot through a particular part of the clotting system.
Activated partial thromboplastin time (aPTT): This evaluates another part of the blood-clotting process.
These tests can help identify certain clotting abnormalities and monitor particular anticoagulant treatments.
A doctor may also request an international normalized ratio (INR), especially for people taking warfarin.
Importantly, normal clotting results do not exclude every possible bleeding disorder.
Platelet-function problems and certain inherited conditions may require additional specialized investigations.
4. Peripheral blood smear
Sometimes a doctor requests a peripheral blood smear.
This involves examining a blood sample under a microscope.
The test allows laboratory professionals to examine the appearance, size, and characteristics of blood cells.
Abnormalities in the number or appearance of certain cells may provide additional clues about what is happening inside the bone marrow.
If leukemia is suspected, further investigations may include specialized blood tests, bone marrow examination, and other diagnostic procedures.
A bone marrow biopsy may be recommended when the initial findings suggest an underlying disorder affecting blood cell production.
It is not a routine test for every person who develops a bruise.
5. Liver and kidney function tests
The liver plays a major role in producing proteins required for normal blood clotting.
Consequently, doctors may investigate liver function when unexplained bruising occurs alongside other symptoms or medical concerns.
Kidney function may also be assessed because certain kidney conditions can affect platelet function and contribute to bleeding problems.
Additional investigations depend on the patient's medical history and examination.
When should you make an appointment?
You should arrange a medical assessment if bruises repeatedly appear without an identifiable cause, become unusually large, or take longer than expected to improve.
It is particularly important to seek evaluation when bruising occurs alongside persistent fatigue, unexplained fever, frequent infections, or unusual bleeding.
The purpose of these examinations is to identify the actual cause rather than guessing based on the appearance of the skin.
According to clinical guidance published by the American Academy of Family Physicians, evaluating unexplained bruising may involve a detailed medical history, physical examination, complete blood count, blood smear, and clotting tests.