Bruising and Exhaustion at College

This page is for students and young adults who have noticed unexplained bruising together with lasting tiredness. It explains when to get checked, what usually causes these symptoms, and what testing involves.

• Call 911 or go to an emergency department if bleeding will not stop after ten minutes of firm pressure. Do the same if you faint, or if you are breathless sitting still. Campus out-of-hours services count here too. Do not drive yourself.
• Call 911 or go to an emergency department if non-blanching spots (spots that do not fade when you press a glass on them) turn up together with a fever. Do the same if they come with feeling very unwell, very cold, confused or short of breath. A rash that stays put under a pressed glass alongside fever can mean meningitis or sepsis. MedlinePlus lists sudden purple, bruise-like spots or pinpoint red spots with fever among the signs of meningococcal meningitis, which can quickly become life-threatening (MedlinePlus). CDC calls sepsis a life-threatening medical emergency (CDC). Do not wait to see whether it spreads.
• Call your care team the same day if pinpoint red or purple non-blanching spots appear on their own, with no fever and no feeling of being unwell.
• Call your care team within a day or two if unexplained bruising has turned up alongside fatigue lasting more than two or three weeks. Also call if bruises appear where nothing hit you, if your gums bleed when you brush, or if you have had several infections in quick succession.

Tiredness alone after an exam period, with no other change, is common. If it lasts, ask your care team whether it needs checking.

Campus and student health services see this pairing regularly, and are used to ordering the test. Name both symptoms together in the same sentence, and say how many weeks each has lasted. Fatigue mentioned on its own reads as student life. Fatigue plus new unexplained bruising reads as a reason to check a blood count. If you left with reassurance but no blood test, and things have not improved, go back and ask about a full blood count.

Both symptoms are extremely common in young adults, and almost always have separate explanations. Exhaustion in student life is most often sleep debt or an irregular schedule. It can also come from:

• A recent viral illness
• Glandular fever (mononucleosis)
• Low iron from heavy periods or a limited diet
• An underactive thyroid
• Depression or anxiety Easy bruising is often just active legs, contact sport, or anti-inflammatory painkillers. Some people have naturally fragile capillaries, a tendency that has been there for years.

Leukemia is rare. This particular pairing has a page of its own for one reason. It is not that it usually means cancer. It is that a single cheap blood test can settle it in a day.

Bone marrow makes three things: red cells, platelets, and white cells. When marrow function is crowded out, all three drop together. So the symptoms arrive as a set rather than one at a time.

• Low red cells produce fatigue that sleep does not fix, pale skin, breathlessness on stairs, and a fast heartbeat.
• Low platelets produce bruises without remembered injury. They turn up in unusual places, such as the trunk, back, or upper arms. Gums bleed when brushing, nosebleeds become frequent, and periods get unusually heavy.
• Low white cells produce infections that keep coming back or will not clear, mouth ulcers, sore throats, and unexplained fevers.

Petechiae (pet-EE-kee-eye) are the sign most worth learning. These are pinpoint red or purple spots, usually on the lower legs. They do not fade when you press a clear glass against them. They are not bruises, and they are not a rash from friction.

UK referral guidance asks clinicians to consider a very urgent full blood count in an adult with any of these:

• pale skin
• persistent fatigue
• unexplained fever
• persistent or recurrent infection
• widespread lymph node swelling
• unexplained bruising
• unexplained bleeding
• petechiae
• an enlarged liver or spleen

Bone pain, drenching night sweats, and unexplained weight loss belong on the same list. Acute leukemia symptoms often build over roughly four to six weeks before diagnosis, and can be mistaken for flu.

The first test is a full blood count with a differential (a count of each type of white cell), usually alongside a blood film (a blood sample looked at under a microscope). It costs very little, and results often come back the same day. It can tell apart ordinary iron deficiency from something that needs urgent attention. Most of these tests come back normal, or show a straightforward, treatable cause.

If the count is abnormal, next steps typically include repeat testing and clotting studies. They also include ferritin, vitamin B12 and folate, liver and kidney function, and LDH, an enzyme test. A blood film is examined for blast cells, meaning immature white blood cells. Where leukemia is suspected, a bone marrow aspiration and biopsy confirms the diagnosis and defines the subtype. Lab tests on the cells and their chromosomes (flow cytometry and cytogenetic analysis) are part of that. The referral moves quickly, often within days.

Bruising with a normal platelet count and normal clotting is common. It is usually left alone once your team has reviewed medication and bleeding history.

• NICE NG12: recommendations organised by site of cancer.
• American Society of Hematology: Leukemia.
• NHS: Acute myeloid leukaemia.
• NCI: Symptoms of Cancer.
• MedlinePlus: Meningococcal meningitis.
• CDC: About sepsis.