When bruising and fatigue may signal a hidden blood disorder

 

MOST of us have experienced unexplained bruising, fatigue, or fever, which we usually brush off as stress, lack of sleep, or a virus that will go away on its own. However, these symptoms could indicate something more serious.

According to Dr Andy Tang Sing Ong, Consultant Clinical & Laboratory Haematologist at Sunway Medical Centre, Sunway City (SMC), these subtle signs may point to underlying blood disorders, and early testing can make all the difference.

One of the most common blood cancers is leukaemia. It occurs when mutations in the DNA of blood-forming cells cause them to multiply uncontrollably. There are acute types, which progress rapidly, and chronic types, which develop more slowly.

“Most leukaemia cases are due to acquired mutations that happen after birth,” Dr Tang said.

“They are not usually inherited. However, if there is a strong family history of multiple cancers across generations, genetic evaluation may be considered.”

On the other hand, non-cancerous blood disorders often involve problems with bleeding or abnormal clotting. These may be inherited, such as haemophilia, or acquired later in life. Others, such as immune thrombocytopenia (ITP), occur when the immune system mistakenly attacks its own platelets.

The symptoms people commonly ignore

big bruises on female arm with copy space

One of the biggest challenges in diagnosing blood disorders is that early symptoms are easy to dismiss.

“People assume bruising is due to minor knocks, or fatigue is due to lack of sleep, but we look at patterns,” stated Dr Tang.

Red flag symptoms that should prompt medical attention include:

• Persistent or unexplained fever lasting more than two to three weeks
• Unusual bruising in areas not typically prone to injury, such as the back or abdomen
• Unexplained gum bleeding
• Frequent infections without clear exposure to sick contacts
• Night sweats, unintentional weight loss, or loss of appetite
• Painless lumps or enlarged lymph nodes that do not go away

“Painless lumps are actually more concerning than painful ones. Painful lumps are often due to infection. Cancerous lumps are usually painless,” he noted.

For parents, recurrent infections in children—especially those requiring repeated hospitalisations—should also raise concern.

Understanding age and lifestyle risk factors

Certain blood cancers are more common in specific age groups. Acute lymphoblastic leukaemia (ALL), for example, is more frequently seen in children, while other forms are more common in older adults.

Environmental and medical risk factors may also play a role, including exposure to radiation, benzene, pesticides, or prolonged use of immunosuppressing medications for autoimmune conditions such as lupus.

Women in their reproductive years are more prone to immune-related blood disorders like ITP and autoimmune anaemia. Additionally, long-term use of oestrogen-containing oral contraceptive pills may increase the risk of blood clots in some women.

“Not everyone with risk factors will develop disease. But awareness helps with early detection,” Dr Tang stressed.

“We start with a detailed history and physical examination. From there, we do basic blood tests. Not everyone needs extensive testing.”

If abnormalities are found in blood tests, such as unexplained low or high blood counts without viral infection, more specialised tests or imaging may be recommended.

A bone marrow biopsy or mutation test is only performed when necessary, such as when there is suspicion of cancer, unexplained persistent fever, or unclear causes of abnormal blood results.

“Bone marrow examination helps us confirm whether there is cancer, infection or an autoimmune issue. It guides the correct treatment,” Dr Tang elaborated.

For most blood tests related to cancer, no fasting or special preparation is required.

Personalised care based on disease type

One common misconception is that all blood cancers require chemotherapy.

“In aggressive or symptomatic cancers, treatment should not be delayed. Chemotherapy remains the backbone, and treatment is usually combined with targeted therapy, immunotherapy, or stem cell transplantation in some cases,” Dr Tang said.

However, some indolent lymphomas may not require immediate treatment if patients have no symptoms and stable blood counts.

“In certain cases, we can watch and wait. Starting treatment too early may not improve survival but may expose patients to unnecessary side effects,” he explained.

For non-cancerous conditions, treatment is different:

• Bleeding disorders may require platelet transfusions or clotting factor replacement
• Blood clots are typically managed with blood-thinning medications tailored to each patient’s needs and risk profile
• Autoimmune disorders often involve steroids or other immune-modulating therapies, carefully monitored to minimise long-term side effects

For some higher-risk leukaemia or relapsed lymphomas, stem cell or bone marrow transplantation may be considered. This can involve using the patient’s own stem cells or cells from a donor.

The importance of acting early

Dr Andy emphasises the importance of seeking medical advice even with mild symptoms.

“Seeking medical advice for mild symptoms is never overreacting. Our body whispers and gives us signs that something is wrong before it gets worse,” he said.

“Never ignore symptoms that persist or worsen despite rest or basic treatment. Early intervention can detect problems at a stage where treatment is more effective and outcomes are better.” ‒  Focus Malaysia