This isn’t the first time I’ve seen it. Someone comes in with a whopper-sized bruise, perhaps with a lump, and is concerned about a blood clot. You’ll almost certainly acquire some bumps in an emergency scenario, but you won’t be able to visit me. Should you be concerned?

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In a nutshell, it’s doubtful. You do have clotted blood, but you also have blood clots and “blood clots.” In fact, if your blood does not clot, you risk bleeding to death.

In tissue outside of the blood vessels, there is bruising-related coagulation. That’s where the bleeding occurred. You’re really concerned about a deep-vein thrombosis (DVT), which is a clot that forms inside a deep-in-the-tissue vein and can break off and travel to the lungs. DVTs are distinct from other types of blood clots in that they are both serious and potentially deadly.

A bruise is not the same as a blood clot. Is it possible for a bruise to lead to a serious blood clot? No, but the blow that caused the bruise can—though this is unusual.

A deep-vein clot can form if the trauma that caused the bruise damages a wide and deep-seated vein’s wall. These veins are located in the tissue and must be struck with precision. This is uncommon, to say the least, and has to do with the impact on the vein’s inner wall. The soft tissue bruising was an accident.

What Should You Do If You Have a DVT?

Doctors aren’t always able to determine whether you have a DVT. A few outside indications are possible, but it’s more likely if your limb swells and becomes painful. Suspect it if your arm or leg swells and is sore—trauma or no trauma.

One test is the Homans’ sign, which implies that DVTs frequently develop in the calves. Simplified: You lie down, toes up, with your foot stretched out. Your doctor grasps your relaxed foot’s sole and bends it quickly, pushing your forefoot back. A severe calf pain indicates a deep-venous blood clot. However, if your doctor suspects you have a DVT, he or she will order an uncommon form of ultrasound examination to see for sure. If you have a DVT, you will be prescribed blood thinners as needed.

If medical help is not available, the best approach for a swollen, red extremity is to keep it still, raise it at heart level or higher, and use mild heat on the area. Visit a doctor as soon as possible.

So What If You Have a Stubborn Bruise That’s Getting In Your Way?

For a bad bruise, treat it with RICE. That’s

  • Rest
  • Ice is good for headaches and similar ailments of the neck and forehead, as well as dry eyes. Use a commercial type or a frozen bag of vegetables, or ice in a zip-close bag. Place a towel between the ice and the skin to prevent burns. It’s possible to use it for anything from five minutes on, ten minutes off, repeat
  • Firm but not too tight, apply an elastic bandage compression. If required, loosen as needed.
  • Elevation at heart level or above.

Unlike with DVT, a simple bruise in the extremity is not harmful.

What If Only the Bruise Is Swollen?

Blood might pool in the soft tissues from time to time, causing a hematoma. If this occurs, a localized region will be swollen and baggy. A hematoma is what it’s called. Aside from RICE, don’t do anything else. It may shrink to a smaller, firmer area—a blood clot—on its own. However, it’s not inside any blood vessels. Trying to drain it outside of a hospital is dangerous due on infection risk.

Don’t be shocked if a considerable region of discoloration appears a few days later. It’s possible that it will follow gravity and affect areas not injured as well. That’s excellent news. The blood from the hematoma is seeping out and being absorbed.

Bottom Line?

Even if a bruise forms, see an expert if your extremity swells or is painful. You never know until you try. However, don’t be too concerned about a minor knot after a fall.

Photo credit: Dan Fitzgerald

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