How Long Should Your Arm Bleed After Blood Draw

Several symptoms may suggest that a person has a bleeding disorder:

• Unexplained nosebleeds (epistaxis)

• Excessive or prolonged menstrual blood flow (menorrhagia)

• Prolonged bleeding after minor cuts, blood drawing, minor surgical or dental procedures, or tooth brushing or flossing

• Unexplained skin marks, including tiny red or purple dots (petechiae), red or purple patches (purpura), bruises (ecchymoses), or small blood vessels that are widened and therefore visible in the skin or mucous membranes (telangiectasias)

Sometimes a laboratory test done for some other reason shows the person has a susceptibility to bleeding.

• Defects in blood vessels

Platelet disorders first cause small red or purple dots on the skin. Later, if the disorder becomes severe, bleeding may occur. A decrease in blood clotting factors usually causes bleeding and bruising. Defects in blood vessels usually cause red or purple spots and patches on the skin, rather than bleeding.

Overall, the most common causes of easy bleeding include

• Severe platelet deficiency

• Liver disease (causing inadequate production of clotting factors)

Doctors first try to establish whether the person's symptoms actually represent easy or excessive bleeding. If so, they look for possible causes. The following information can help people know when to see a doctor and help them know what to expect during the evaluation.

In people with easy bruising or bleeding, certain symptoms and characteristics are cause for concern. They include

• Symptoms of serious blood loss, such as sweating, weakness, faintness or dizziness, nausea, or extreme thirst

• Pregnancy or recent delivery

• Signs of infection, such as fever, chills, diarrhea, or feeling ill all over

• Headache, confusion, or other sudden symptoms related to the brain or nervous system

People with warning signs should see a doctor right away, as should those who are still bleeding and those who have lost more than a small amount of blood. People without warning signs who notice that they bleed or bruise easily should call their doctor. The doctor determines how quickly to evaluate people based on their symptoms and other factors. Typically, people who do not feel well or have risk factors for bleeding, such as liver disease or use of certain drugs, or who have a family history of a bleeding disorder should be seen within a day or two. People who feel well but had a few nosebleeds that stopped on their own or who have bruises or spots on their skin can be seen when practical. A delay of a week or so is unlikely to be harmful.

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination sometimes suggests a cause of the bleeding or bruising, but typically tests need to be done.

Doctors ask about types of bleeding, including frequent nosebleeds, gum bleeding while tooth brushing, coughing up blood (hemoptysis), blood in stool or urine, or dark tarry stool (melena). They also ask about other symptoms, including abdominal pain and diarrhea (suggesting a digestive disorder), joint pain (suggesting a connective tissue disorder), and lack of menstrual periods and morning sickness (suggesting pregnancy). They ask about whether the person is taking drugs (such as aspirin, indomethacin, heparin, or warfarin) that are known to increase the risk of bleeding. Easy bleeding in a person taking warfarin, especially if the dose has recently increased, is likely due to the drug. Doctors also ask if the person has a condition that is likely to cause a problem with blood clotting, such as

• Severe infection, cancer, liver disease Overview of Liver Disease Liver disease can manifest in many different ways. Characteristic manifestations include Jaundice (a yellowish discoloration of the skin and whites of the eyes) Cholestasis (reduction or stoppage... read more (such as cirrhosis or hepatitis), human immunodeficiency virus infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS). HIV is transmitted... read more (HIV infection), pregnancy, systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Problems in the... read more (lupus), or chronic kidney disease Chronic Kidney Disease Chronic kidney disease is a slowly progressive (months to years) decline in the kidneys' ability to filter metabolic waste products from the blood. Major causes are diabetes and high blood pressure... read more

• Family history of excessive bleeding

People are asked about use of alcohol or intravenous (IV) drugs. Heavy alcohol use is a risk factor for liver disease, and IV drug use is a risk factor for HIV infection.

During the physical examination, doctors check vital signs (temperature, blood pressure, and heart rate). These signs can give an early indication of serious disorders, especially low blood volume or an infection. A high heart rate together with low blood pressure suggests low blood volume due to bleeding. Fever suggests an infection.

Doctors examine the skin and mucous membranes (nose, mouth, and vagina) looking for signs of bleeding. A digital rectal examination is done to look for bleeding from the digestive tract. Doctors also look for signs, such as tenderness during movement and local swelling, that may indicate bleeding in deeper tissues. A person with bleeding inside the head may have confusion, a stiff neck, or neurologic abnormalities (such as headache, vision problems or weakness). The sites of bleeding may offer a clue to the cause. Bleeding from superficial sites, including skin and mucous membranes, suggests a problem with platelets or blood vessels. On the other hand, bleeding into deep tissues suggests a problem with clotting.

Additional findings may help doctors narrow the cause. Accumulation of fluid in the abdomen (ascites), an enlarged spleen (splenomegaly), and yellow color of the skin and/or eyes (jaundice) suggest bleeding caused by liver disease. A woman who is pregnant or has recently delivered or a person who is in shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more or has a fever, chills, and other signs of serious infection is at risk of disseminated intravascular coagulation Disseminated Intravascular Coagulation (DIC) Disseminated intravascular coagulation is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets... read more . In children, fever and digestive upset, especially bloody diarrhea, suggest hemolytic-uremic syndrome Hemolytic-Uremic Syndrome (HUS) Hemolytic-uremic syndrome (HUS) is a serious disorder that usually occurs in children and involves the formation of small blood clots throughout the body that block the flow of blood to vital... read more . A rash on the legs, joint pain, and digestive upset suggest immunoglobulin─A associated vasculitis Immunoglobulin A–Associated Vasculitis Immunoglobulin A–associated vasculitis (formerly called Henoch-Schönlein purpura) is inflammation of mainly small blood vessels that most often occurs in children. A rash of reddish purple bumps... read more .

Most people with excessive bleeding require blood tests. The initial tests are

• Peripheral blood smear (examination of a sample of blood under a microscope to see whether blood cells are damaged, abnormal, or immature)

These tests are considered screening tests. They are done to determine whether the clotting system is normal. If one of these tests reveals an abnormality, additional tests are usually needed to identify the cause.

The specific treatment for easy bruising and bleeding depends on the cause. For example,

• Cancers and infections are treated

• Causative drugs are stopped

• Vitamins are given for vitamin deficiency

• People with liver disease are sometimes given vitamin K or fresh frozen plasma transfusions

People with easy bruising due to skin and blood vessel fragility do not need to be treated, although doctors sometimes suggest that people avoid taking aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

Older people may be more prone to easy bruising. As people age, the skin thins and people lose some of the protective layer of fat below the skin surface. So a minor bump is more likely to cause blood vessels to break, leading to bruising. Also, the small blood vessels themselves become less elastic and more fragile, leading to easier bruising. Older people also are more likely to take aspirin, clopidogrel, warfarin, or direct oral anticoagulants, which make bruising and bleeding more likely.

• Excessive bleeding may occur on its own or after minor injury.

• Bleeding can range from minimal to massive and is very dangerous if it occurs within the brain.

• Liver disease, low platelet count, and certain drugs (especially warfarin, heparin, aspirin, and nonsteroidal anti-inflammatory drugs ) are common causes.

• Disseminated intravascular coagulation is an uncommon but serious cause that most often develops in people who are already ill or in the hospital.

• Easy bruising is common and is rarely a cause for concern if people feel well and have no other signs of easy bleeding.

Generic Name	Select Brand Names
indomethacin	INDOCIN
clopidogrel	PLAVIX
rivaroxaban	XARELTO
quinidine	No US brand name
warfarin	COUMADIN
rifampin	RIFADIN, RIMACTANE
apixaban	ELIQUIS
edoxaban	SAVAYSA
quinine	QUALAQUIN
heparin	PANHEPRIN

How Long Should Your Arm Bleed After Blood Draw

Source: https://www.merckmanuals.com/home/blood-disorders/blood-clotting-process/bruising-and-bleeding

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