Bruising and Exhaustion at College

Both symptoms are extremely common in young adults, and almost always separately explained. Exhaustion in student life is most often sleep debt, an irregular schedule, a recent viral illness, glandular fever, low iron from heavy periods or a limited diet, an underactive thyroid, depression or anxiety. Easy bruising is often just active legs, contact sport, anti-inflammatory painkillers, or a naturally fragile-capillary tendency that has been there for years.

Leukaemia is rare. The reason this particular pairing has a page of its own is not that it usually means cancer, but that it is one of the few combinations a single cheap blood test can settle in a day.

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

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

Petechiae are the sign most worth learning. These are pinpoint red or purple spots, usually on the lower legs, that 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: pallor, persistent fatigue, unexplained fever, persistent or recurrent infection, generalised lymph node swelling, unexplained bruising, unexplained bleeding, petechiae, or an enlarged liver or spleen. Bone pain, drenching night sweats and unexplained weight loss belong on the same list. Acute leukaemia 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, usually alongside a blood film. It costs very little, results often come back the same day, and it distinguishes 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, clotting studies, ferritin, vitamin B12 and folate, liver and kidney function, and LDH. A blood film is examined for blast cells. Where leukaemia is suspected, a bone marrow aspiration and biopsy with flow cytometry and cytogenetic analysis confirms the diagnosis and defines the subtype. That referral moves quickly, often within days.

Bruising with a normal platelet count and normal clotting is common and is usually left alone once medication and bleeding history have been reviewed.

Tiredness alone after an exam period, with no other change, does not need a blood test this week. It needs sleep, and a review if it persists past a month.

Book an appointment within a few days if unexplained bruising has appeared alongside fatigue lasting more than two or three weeks, if bruises are turning up where nothing hit you, if gums bleed when you brush, or if you have had several infections in quick succession.

Seek same-day care for petechiae that do not blanch, a fever with feeling genuinely unwell, bleeding that will not stop after ten minutes of firm pressure, breathlessness at rest, or fainting.

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 leave with reassurance but no blood test and things do not improve, going back and asking directly for a full blood count is a reasonable thing to do.

• NICE NG12: recommendations organised by site of cancer
• American Society of Hematology: Leukemia
• NHS: Acute myeloid leukaemia
• NCI: Symptoms of Cancer