Özlem CANDAN, Büşra ERDOĞAN, Dilek KESKİN
Comprehensive Medicine - 2026;18(3):259-265
Objective: Spontaneous ecchymosis is a common yet diagnostically challenging reason for referral to hematology clinics, particularly when platelet counts and routine coagulation tests are normal. In this setting, the diagnostic value of clinical phenotype, bleeding history, and bleeding assessment tools remains uncertain. Materials and Methods: We conducted a single-center, real-world, observational cross-sectional study including adult patients presenting with spontaneous or recurrent ecchymosis. All patients had normal platelet counts and normal screening coagulation tests and were not receiving antithrombotic therapy. Bleeding severity was assessed using the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT). Laboratory evaluation included von Willebrand factor (vWF) antigen and activity, factor VIII (FVIII), and factor XIII (FXIII) activity. Results: A total of 143 patients were included (median age: 33 years; 97.2% female). A definitive hemostatic abnormality was identified in 58 patients (40.6%). Abnormal vWF parameters were observed in 25.2% of patients, while reduced FVIII and FXIII levels were detected in 14.0% and 7.7%, respectively. Using conventional sex-specific ISTH-BAT cutoffs, only one patient met the criteria for a pathological BAT score. In contrast, median ISTH-BAT scores were significantly higher in patients with identifiable laboratory abnormalities compared with those without (p=0.047). Clinical features such as ecchymosis distribution and pain were not associated with laboratory abnormalities. Conclusion: In patients presenting with spontaneous ecchymosis, clinical phenotype and standard bleeding score cutoffs have limited diagnostic utility. Interpreting the ISTH-BAT score as a continuous measure of bleeding burden provides clinically meaningful information and may better support diagnostic decision-making in real-world practice.
