Hematology and Oncology Book

Coagulopathy

Platelet Disorders

Rheumatology

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PurpuraAka: Purpuric rash, Petechiae, Ecchymosis, Ecchymoses

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  1. See Also
    1. Purpura Causes
  2. Definitions
    1. Petechiae: Pinpoint hemorrhages <2 mm in diameter
    2. Purpura: 2 to 10 mm in diameter
    3. Ecchymosis: >10 mm in diameter
  3. Signs: Purpura
    1. Visible non-blanching hemorrhages
    2. Occurs in the skin or mucus membranes
    3. Size: 2-10 mm in diameter (see definitions above)
    4. Palpable purpura suggests Vasculitis
    5. Purpura on Lower extremities
      1. Henoch-Schonlein Purpura
    6. Purpura on palms and soles
      1. Rickettsial infection
  4. Signs: Associated Conditions
    1. Hypertension
      1. Chronic Renal Failure
      2. Renal Vasculitis
    2. Hemarthrosis
      1. Hemophilia
    3. Skeletal abnormalities
      1. Thrombocytopenia-absent radii (TAR syndrome)
      2. Fanconi's Anemia (short stature)
    4. Skin hyperelasticity and joint hypermobility
      1. Ehlers-Danlos Syndrome
    5. Telangiectases
      1. Hereditary Hemorrhagic Telangiectasia
      2. Liver disease
  5. Labs: Complete Blood Count and Peripheral Smear
    1. Schistocytes
      1. Hemolytic-Uremic Syndrome
      2. Thrombotic Thrombocytopenic Purpura
      3. Disseminated Intravascular Coagulopathy
    2. Atypical Lymphocytosis
      1. Infectious Mononucleosis
      2. Cytomegalovirus
      3. Leukemia blast cells with similar appearance
    3. Reticulocyte Count increased
      1. Hemolytic Anemia
  6. Labs: Platelet Count and Indices
    1. Anemia and Thrombocytopenia
      1. Leukemia
      2. Systemic Lupus Erythematosus
      3. Aplastic Anemia
    2. Thrombocytopenia with otherwise normal CBC
      1. Idiopathic Thrombocytopenic Purpura
    3. Altered platelet size
      1. See Mean Platelet Volume (MPV)
  7. Labs: Urinalysis with Hematuria
    1. Henoch-Schonlein Purpura
    2. Systemic Lupus Erythematosus
    3. Hemolytic-Uremic Syndrome
  8. Causes
    1. See Purpura Causes
  9. Approach in Children: Step 1 (non-bleeding cause)
    1. If unable to identify cause, go to step 2 below
    2. Identify potential cause based on history and exam
      1. See Purpura Causes
      2. See Signs above
  10. Approach in Children: Step 2 (bleeding cause)
    1. Obtain Bleeding Disorder lab-work
      1. Complete Blood Count (CBC) with Platelet Count
      2. Peripheral blood smear
      3. ProTime
      4. Activated Partial Thromboplastin Time (aPTT)
    2. Evaluate Platelet Count
      1. Platelet Count low: Go to Step 3a below
      2. Platelet Count normal: Go to Step 3b below
  11. Approach in Children: Step 3a (Low Platelet Count)
    1. See Thrombocytopenia
    2. Prothrombin Time and aPTT prolonged
      1. Sepsis
      2. Disseminated Intravascular Coagulopathy
    3. Prothrombin Time and aPTT not prolonged
      1. Idiopathic Thrombocytopenic Purpura
      2. Hemolytic-Uremic Syndrome
      3. Thrombotic Thrombocytopenic Purpura
      4. Systemic Lupus Erythematosus
      5. Bone Marrow aplasia
      6. Platelet Sequestration
  12. Approach in Children: Step 3b (Normal Platelet Count)
    1. Prothrombin Time and aPTT prolonged
      1. Coagulation Factor deficiency
      2. Von Willebrand's Disease
      3. Circulating anticoagulant
      4. Liver disease
    2. Prothrombin Time and aPTT not prolonged
      1. Go to Step 4 below
  13. Approach in Children: Step 4 (Bleeding Time)
    1. Obtain Bleeding Time
    2. Bleeding Time prolonged
      1. See Platelet Dysfunction
      2. Von Willebrand's Disease
    3. Bleeding Time normal
      1. Child Abuse
      2. Von Willebrand's Disease
      3. Vascular purpura
  14. Precautions for patients with bleeding tendency
    1. No strenuous activity or contact sport
    2. No intramuscular injections
    3. Avoid Aspirin and NSAIDs
  15. References
    1. Baselga (1997) J Am Acad Dermatol 37:673
    2. Leung (2001) Am Fam Physician 64(3):419
    3. Stevens (1995) Am Fam Physician 52(5):1355

Ecchymosis (C0013491)

Definition (MSH)Extravasation of blood into the skin, resulting in a nonelevated, rounded or irregular, blue or purplish patch, larger than a petechia.
Definition (NCI)A small bruise caused by blood leaking from broken blood vessels into the tissues of the skin or mucous membranes.
ConceptsFinding (T033)
EnglishEcchymoses, Ecchymosis
Spanishequimosis
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Purpura (C0034150)

Definition (MSH)Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues.
Definition (CSP)small hemorrhage in the skin, mucous membrane or serosal surface, or a group of hemorrhagic diseases characterized by purpuric lesions.
ConceptsDisease or Syndrome (T047)
ICD9287.2
EnglishDisorder characterised by purpura, Disorder characterized by purpura, Peliosis, Purpura, Purpuras, Purpuric disorder
Spanishenfermedad purpúrica, enfermedad purpurica, púrpura, peliosis, purpura, trastorno caracterizado por púrpura, trastorno caracterizado por purpura, trastorno purpúrico, trastorno purpurico
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Purpuric rash (C0151882)

ConceptsDisease or Syndrome (T047)
EnglishPurpuric rash, Purpuric rashes, RASH PURPITIC, RASH PURPURIC
Spanisherupción purpúrica, erupcion purpurica
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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