ELDER TIP In older adults, platelet characteristics change. Granular constituents decrease and platelet-release factors increase. These changes may reflect diminished bone marrow and increased fibrinogen levels.
An idiopathic form of thrombocytopenia commonly occurs in children. A transient form may follow viral infection (such as Epstein-Barr virus or infectious mononucleosis).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Allergic purpuras:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The most common identifiable cause of allergic purpura is probably an autoimmune reaction directed against vascular walls, triggered by a bacterial infection (particularly streptococcal infection). Typically, upper respiratory tract infection occurs 1 to 3 weeks before the onset of symptoms. Other possible causes include allergic reactions to some drugs and vaccines, to insect bites, and to some foods (such as wheat, eggs, milk, and chocolate).
Allergic purpura affects more males than females and is most prevalent in children ages 3 to 7. The prognosis is more favorable for children than adults.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Idiopathic thrombocytopenic purpura:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
ITP may be an autoimmune disorder, because antibodies that reduce the life span of platelets have been found in nearly all patients. The spleen probably helps to remove platelets modified by the antibody. Acute ITP usually follows a viral infection, such as rubella or chickenpox, and can follow immunization with a live virus vaccine. Chronic ITP seldom follows infection and is commonly linked to immunologic disorders such as systemic lupus erythematosus. It’s also linked to drug reactions. ITP frequently occurs in patients who have abused alcohol, heroin, or morphine, and in patients with acquired immunodeficiency syndrome who are exposed to the rubella virus.
Acute ITP usually affects children between ages 2 and 6; chronic ITP mainly affects adults younger than age 50, especially women between ages 20 and 40.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Purpura:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Amyloidosis
This disorder produces purpura that appears either spontaneously on dependent areas of the skin or following minor trauma, coughing, or straining. The eyelids and mucous membranes are commonly affected.
Autoerythrocyte sensitivity
With this syndrome, painful ecchymoses appear either singly or in groups, usually preceded by local itching, burning, or pain. Common associated findings include epistaxis, hematuria, hematemesis, and menometrorrhagia. Abdominal pain, diarrhea, nausea, vomiting, syncope, headache, and chest pain are also common.
Cholesterol emboli
Purpura due to cholesterol emboli are most commonly found in the lower extremities of patient with atherosclerotic vascular disease and usually occur after anticoagulation therapy or an invasive arterial procedure such as angiogram or cardiac catheterization but may occur spontaneously. Associated findings include livedo reticularis, cyanosis, gangrene, nodules and ulceration of the skin.
Dermatoses (pigmented)
This group of disorders, thought to result from chronic stasis, produces benign, chronic purpura, mainly on dependent areas.
Disseminated intravascular coagulation
This disorder can cause varying degrees of purpura, depending on its severity and underlying cause. Rarely, the patient develops life-threatening purpura fulminans, with symmetrical cutaneous and subcutaneous lesions on the arms and legs, or he may have cutaneous oozing, hematemesis, or bleeding from incision or needle insertion sites. Other findings include acrocyanosis; nausea; dyspnea; seizures; severe muscle, back, and abdominal pain; and signs of acute tubular necrosis, such as oliguria.
Dysproteinemias
With multiple myeloma, petechiae and ecchymoses accompany other bleeding tendencies: hematemesis, epistaxis, gum bleeding, and excessive bleeding after surgery. Similar findings occur with cryoglobulinemia, which may also produce malignant maculopapular purpura. Hyperglobulinemia typically begins insidiously with occasional outbreaks of purpura over the lower legs and feet. These outbreaks eventually become more frequent and extensive, involving the entire lower leg and possibly the trunk. The purpura usually occurs after prolonged standing or exercise and may be heralded by skin burning or stinging. Leg edema, knee or ankle pain, and low-grade fever may precede or accompany the purpura, which gradually fades over 1 to 2 weeks. Persistent pigmentation develops after repeated outbreaks.
Easy bruising syndrome
This syndrome is characterized by recurrent bruising on the legs, arms, and trunk, either spontaneously or following minor trauma. Bruising may be preceded by pain and is more common in women than in men, especially during menses.
Ehlers-Danlos syndrome (EDS)
Besides petechiae, this syndrome is marked by easy bruising, epistaxis, gum bleeding, hematuria, melena, menorrhagia, and excessive bleeding after surgery. EDS characteristically produces soft, velvety, hyperelastic skin; hyperextensible joints; increased skin and blood vessel fragility; and repeated dislocations of the temporomandibular joint.
Fat emboli
Petechiae that occur on the upper body a few days after a major injury are caused by fat emboli.
Idiopathic thrombocytopenic purpura (ITP)
Chronic ITP typically begins insidiously, with scattered petechiae that are usually found on the distal arms and legs. Deep-lying ecchymoses may also occur. Other findings include epistaxis, easy bruising, hematuria, hematemesis, and menorrhagia.
Leukemia
This disease produces widespread petechiae on the skin, mucous membranes, retina, and serosal surfaces that persist throughout the course of the disease. Confluent ecchymoses are uncommon. The patient may also exhibit swollen and bleeding gums, epistaxis, and other bleeding tendencies. Lymphadenopathy and splenomegaly are common.
Acute leukemias also produce severe prostration and high fever and may cause dyspnea, tachycardia, palpitations, and abdominal or bone pain. Confusion, headache, seizures, vomiting, papilledema, and nuchal rigidity may occur late in the disease. Chronic leukemias begin insidiously with minor bleeding tendencies, malaise, fatigue, pallor, low-grade fever, anorexia, and weight loss.
Liver disease
Liver disease may cause purpura, particularly ecchymoses, and other bleeding tendencies. Associated findings include hepatomegaly, ascites, right-upper-quadrant pain, jaundice, nausea, vomiting, and anorexia.
Lymphomas
T-cell (Hodgkin’s) lymphomas initially may produce erythematous patches with some scaling. These lesions, which may be psoriasiform or parapsoriasiform, then become interspersed with nodules. Pruritus and discomfort are common. Later, tumors and ulcerations form, and nontender lymphadenopathy develops.
B-cell (non-Hodgkin’s) lymphoma may produce a scaling dermatitis with pruritus, which usually begins on the legs and then affects the entire body. Small pink-to-brown nodules and diffuse pigmentation also occur. B-cell lymphomas typically produce painless peripheral lymphadenopathy, usually affecting the cervical nodes first. Other findings in both types of lymphoma include fever, fatigue, malaise, weight loss, and hepatosplenomegaly.
Meningococcemia
Transmitted by droplet inhalation, it’s most common in children and caused by Neisseria meningitidis. Cutaneous and oropharyngeal petechia and purpura are initially discrete but become confluent, developing into hemorrhagic bullae and ulcerations. Fulminant infection results in extensive purpura and ecchymosis with irregular borders (purpura fulminans) most notably on the extremities. These lesions may develop necrotic centers. This disease is usually fatal if not recognized and treated early. Prognosis is poor when purpura or ecchymosis is present at the time of diagnosis. Associated symptoms include spiking fevers, chills, myalgia and arthralgia, and recent upper respiratory tract infection. Rapid progression of symptoms leads to headache, neck stiffness and nuchal rigidity. Septic shock ensues within hours on onset of symptoms with altered mental status and hypotension.
Myeloproliferative disorders
These disorders, which include polycythemia vera, paradoxically can cause hemorrhage accompanied by ecchymoses and ruddy cyanosis. The oral mucosa takes on a deep purplish red hue, and slight trauma causes swollen gums to bleed. Other findings include pruritus, urticaria, and such nonspecific signs and symptoms as lethargy, weakness, fatigue, and weight loss. The patient typically complains of headache, a sensation of fullness in the head, and rushing in the ears; dizziness and vertigo; dyspnea; paresthesia of the fingers; double or blurred vision and scotoma; and epigastric distress. He may also experience intermittent claudication, hypertension, hepatosplenomegaly, and impaired mentation.
Nutritional deficiencies
With vitamin C deficiency (scurvy), the characteristic pattern of purpura is perifollicular petechiae, which coalesce to form ecchymoses, in the “saddle area” of the thighs and buttocks. Additional hemorrhaging occurs in arm and leg muscles (with phlebothrombosis), viscera, joints (with limb and joint pain), and nail beds. Related findings include scaly dermatitis; pallor; tender, swollen, bleeding gums and loosened teeth; dry mouth; and poor wound healing. Nonspecific symptoms include weakness, lethargy, and anorexia. Irritability, depression, insomnia, and hysteria may also develop.
Vitamin K deficiency produces abnormal bleeding tendencies, such as ecchymosis, gum bleeding, epistaxis, hematuria, and GI and intracranial bleeding.
Vitamin B12 deficiency can cause varying degrees of purpura. GI findings include anorexia, nausea, vomiting, weight loss, abdominal discomfort, and jaundice. Dyspnea, peripheral neuropathies, ataxia, glossitis and, occasionally, depression also occur.
Folic acid deficiency also can cause varying degrees of purpura. The patient may be irritable and forgetful and complain of fatigue, weakness, dyspnea, palpitations, nausea, anorexia, headaches, and fainting spells. Additional findings include pallor, slight jaundice, and glossitis.
Rocky Mountain spotted fever
This illness is contracted through the bite of an infected tick and is most common among children between ages 5 and 10. Initial skin lesions are small pink macules that evolve into blatant petechia and palpable purpura. Hemorrhagic macules may develop. The palms and soles are particularly affected. Extensive cutaneous necrosis occurs due to disseminated intravascular coagulation in a small percentage of patients experiencing gangrene of the extremities, necessitating amputation. Associated signs and symptoms include fever, severe headache, generalized myalgia, photophobia, nausea and vomiting. Late in the course of the illness, shock and death may occur.
Septicemia
Thrombocytopenia or the effects of toxins in acute infection can lead to purpura, especially in the form of petechiae. Associated findings include fever, chills, headache, tachycardia, lethargy, diaphoresis, and anorexia. Signs and symptoms specific to the area of infection—for example, cough, wound drainage, and urinary burning—also occur.
Stasis
Chronic stasis usually affects the elderly, producing dusky reddish purpura on the legs after prolonged standing.
Systemic lupus erythematosus
This chronic inflammatory disorder may produce purpura accompanied by other cutaneous findings, such as scaly patches on the scalp, face, neck, and arms; diffuse alopecia; telangiectasia; urticaria; and ulceration. The characteristic butterfly rash appears in the disorder’s acute phase. Common associated signs and symptoms include nondeforming joint pain and stiffness, Raynaud’s phenomenon, seizures, psychotic behavior, photosensitivity, fever, anorexia, weight loss, and lymphadenopathy.
Thrombotic thrombocytopenic purpura
Generalized purpura, hematuria, vaginal bleeding, jaundice, and pallor are among the usual presenting signs and symptoms in this disorder. Most patients have fever, and some also experience fatigue, weakness, headache, nausea, abdominal pain, arthralgias, and hepatosplenomegaly. Possible neurologic effects include seizures, paresthesia, cranial nerve palsies, vertigo, and altered level
of consciousness. Renal failure may also occur.
Trauma
Traumatic injury can cause local or widespread purpura.
Vasculitis
Palpable purpura is commonly caused by allergic vasculitis (leukocytoclastic vasculitis) of which Henoch-Schönlein purpura is one subtype. Most common in adolescents and children, lesions can be found anywhere on the body but are most prevalent on the lower extremities and buttocks. The purpura tends to be smooth, bordered, and circular in nature. Systemic signs and symptoms include fever, arthralgias, abdominal pain, GI bleeding and nephritis.
Other causes
Diagnostic tests
Invasive procedures, such as venipuncture and arterial catheterization, may produce local ecchymoses and hematomas due to extravasated blood.
Drugs
The anticoagulants heparin and warfarin can produce purpura. Administration of warfarin can result in painful areas of erythema that become purpuric then necrotic with an adherent black eschar. The lesions develop between the 3rd and 10th day of drug administration.
Surgery and other procedures
Any procedure that disrupts circulation, coagulation, or platelet activity or production can cause purpura. These include pulmonary and cardiac surgery, radiation therapy, chemotherapy, hemodialysis, multiple blood transfusions with platelet-poor blood, and use of plasma expanders such as dextran.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Purpura/Petechiae/Excessive Bleeding:
Differential Overview
(Field Guide to Bedside Diagnosis)
Purpura
❑Trauma
❑Senile purpura
❑Drugs
❑Vasculitis
❑Vitamin K deficiency
❑Psychogenic purpura
❑Cholesterol emboli
❑Warfarin necrosis
❑Scurvy
❑Thrombotic thrombocytopenic purpura
❑Henoch-Schonlein purpura
❑Amyloidosis
Petechiae
❑Autoimmune thrombocytopenia
❑Bacteremia
❑Hypersplenism
Excessive Bleeding
❑Over-anticoagulation
❑Thrombocytopenia
❑von Willebrand disease
❑Circulating anticoagulant
❑Disseminated intravascular coagulation
❑Hemophilia
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Thrombocytopenia:
Causes
(Handbook of Diseases)
Thrombocytopenia may be congenital or acquired; the acquired form is more common. In either case, it usually results from the following:
❑ decreased or defective production of platelets in the marrow (such as occurs in leukemia, aplastic anemia, or toxicity with certain drugs)
❑ increased destruction outside the marrow caused by an underlying disorder (such as cirrhosis of the liver, disseminated intravascular coagulation, or severe infection)
❑ less commonly, sequestration (hypersplenism, hypothermia) or platelet loss.
Acquired thrombocytopenia may result from certain drugs, such as nonsteroidal anti-inflammatory agents, sulfonamides, histamine blockers, alkylating agents, heparin, alcohol, or antibiotic chemotherapeutic agents.
An idiopathic form of thrombocytopenia commonly occurs in children. A transient form may follow viral infections (Epstein-Barr or infectious mononucleosis).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Allergic purpura:
Causes
(Handbook of Diseases)
The most common identifiable cause of allergic purpura is probably an autoimmune reaction directed against vascular walls, triggered by a bacterial infection (particularly streptococcal infection). Typically, an upper respiratory tract infection occurs 1 to 3 weeks before the onset of symptoms. Other possible causes include allergic reactions to some drugs and vaccines, allergic reactions to insect bites, and allergic reactions to some foods (such as wheat, eggs, milk, and chocolate).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Idiopathic thrombocytopenic purpura:
Causes
(Handbook of Diseases)
ITP may be an autoimmune disorder because antibodies that reduce the life span of platelets have been found in nearly all patients. The spleen probably helps to remove platelets modified by the antibody. Acute ITP usually follows a viral infection, such as rubella and chickenpox, and can follow immunization with a live virus vaccine. Chronic ITP seldom follows infection and is commonly linked to immunologic disorders, such as systemic lupus erythematosus or human immunodeficiency virus infection. It’s also linked to drug reactions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chronic fatigue and immune dysfunction syndrome:
Causes
(Handbook of Diseases)
Although the cause of CFIDS is unknown, researchers suspect that it may be found in human herpesvirus 6 or in other herpesviruses, enteroviruses, or retroviruses. Rising levels of antibodies to EBV, once thought to implicate EBV infection as the cause of CFIDS, are now considered a result of this disease.
CFIDS may be associated with a reaction to viral illness that’s complicated by dysfunctional immune response and by other factors that may include sex, age, genetic disposition, prior illness, stress, and environment.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Purpura:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Cholesterol emboli
Purpura caused by cholesterol emboli are most commonly found in the lower extremities of patients with atherosclerotic vascular disease and usually occur after anticoagulation therapy or an invasive arterial procedure, such as angiogram or cardiac catheterization; however, they may occur spontaneously. Associated findings include livedo reticularis, cyanosis, gangrene, nodules, and ulceration of the skin.
Disseminated intravascular coagulation
Disseminated intravascular coagulation (DIC) can cause varying degrees of purpura, depending on its severity and underlying cause. The patient may have cutaneous oozing, hematemesis, or bleeding from incision or needle insertion sites. Other findings include acrocyanosis; nausea; dyspnea; seizures; severe muscle, back, and abdominal pain; and signs of acute tubular necrosis, such as oliguria.
Dysproteinemias
With multiple myeloma, petechiae and ecchymoses accompany other bleeding tendencies: hematemesis, epistaxis, gum bleeding, and excessive bleeding after surgery. Similar findings occur with cryoglobulinemia, which may also produce malignant maculopapular purpura. Hyperglobulinemia typically begins insidiously with occasional outbreaks of purpura over the lower legs and feet. These outbreaks eventually become more frequent and extensive, involving the entire lower leg and possibly the trunk. The purpura usually occurs after prolonged standing or exercise and may be heralded by skin burning or stinging. Leg edema, knee or ankle pain, and low-grade fever may precede or accompany the purpura, which gradually fades over 1 to 2 weeks. Persistent pigmentation develops after repeated outbreaks.
Easy bruising syndrome
Easy bruising syndrome is characterized by recurrent bruising on the legs, arms, and trunk, either spontaneously or following minor trauma. Bruising may be preceded by pain and is more common in women than in men, especially during menses.
Fat emboli
Petechiae that occur on the upper body a few days after a major injury are caused by fat emboli. The patient may experience fever, tachycardia, tachypnea, blood-tinged sputum, cyanosis, anxiety, restlessness, altered level of consciousness, seizures, coma, or rash.
Idiopathic thrombocytopenic purpura
Chronic idiopathic thrombocytopenic purpura (ITP) typically begins insidiously, with scattered petechiae that are usually found on the distal arms and legs. Deep-lying ecchymoses may also occur. Other findings include epistaxis, easy bruising, hematuria, hematemesis, and menorrhagia.
Leukemia
Leukemia produces widespread petechiae on the skin, mucous membranes, retina, and serosal surfaces that persist throughout the course of the disease. The patient may also exhibit swollen and bleeding gums, epistaxis, and other bleeding tendencies. Lymphadenopathy and splenomegaly are common.
Acute leukemias also produce severe prostration and high fever and may cause dyspnea, tachycardia, palpitations, and abdominal or bone pain. Confusion, headache, seizures, vomiting, papilledema, and nuchal rigidity may occur late in the disease. Chronic leukemias begin insidiously with minor bleeding tendencies, malaise, fatigue, pallor, low-grade fever, anorexia, and weight loss.
Liver disease
Hepatic disease may cause purpura, particularly ecchymoses, and other bleeding tendencies. Associated findings include hepatomegaly, ascites, right-upper-quadrant pain, jaundice, nausea, vomiting, and anorexia.
Meningococcemia
With meningococcemia, cutaneous and oropharyngeal petechia and purpura are initially discrete but become confluent, developing into hemorrhagic bullae and ulcerations. Fulminant infection results in extensive purpura and ecchymosis with irregular borders (purpura fulminans), most notably on the extremities. These lesions may develop necrotic centers. Associated symptoms include spiking fevers, chills, myalgia and arthralgia, and recent upper respiratory tract infection. Rapid progression of symptoms leads to headache, neck stiffness, and nuchal rigidity. Septic shock ensues within hours of onset of symptoms, accompanied by altered mental status and hypotension.
Myeloproliferative disorders
Myeloproliferative disorders, which include polycythemia vera, paradoxically can cause hemorrhage accompanied by ecchymoses and ruddy cyanosis. The oral mucosa takes on a deep purplish red hue, and slight trauma causes swollen gums to bleed. Other findings include pruritus, urticaria, and such nonspecific signs and symptoms as lethargy, weakness, fatigue, and weight loss. The patient typically complains of headache, a sensation of fullness in the head, and rushing in the ears; dizziness and vertigo; dyspnea; paresthesia of the fingers; double or blurred vision and scotoma; and epigastric distress. He may also experience intermittent claudication, hypertension, hepatosplenomegaly, and impaired mentation.
Nutritional deficiencies
With vitamin C deficiency (scurvy), the characteristic pattern of purpura is perifollicular petechiae, which coalesce to form ecchymoses, in the “saddle area” of the thighs and buttocks. Additional hemorrhaging occurs in arm and leg muscles (with phlebothrombosis), viscera, joints (with limb and joint pain), and nail beds. Related findings include scaly dermatitis; pallor; tender, swollen, bleeding gums and loosened teeth; dry mouth; and poor wound healing. Nonspecific symptoms include weakness, lethargy, and anorexia. Irritability, depression, insomnia, and hysteria may also develop.
Vitamin K deficiency produces abnormal bleeding tendencies, such as ecchymosis, gum bleeding, epistaxis, hematuria, and GI and intracranial bleeding.
Vitamin B12 deficiency can cause varying degrees of purpura. GI findings include anorexia, nausea, vomiting, weight loss, abdominal discomfort, and jaundice. Dyspnea, peripheral neuropathies, ataxia, glossitis and, occasionally, depression also occur.
Folic acid deficiency also can cause varying degrees of purpura. The patient may be irritable and forgetful and may complain of fatigue, weakness, dyspnea, palpitations, nausea, anorexia, headaches, and fainting spells. Additional findings include pallor, slight jaundice, and glossitis.
Rocky Mountain spotted fever
The initial skin lesions of Rocky Mountain spotted fever are small pink macules that evolve into blatant petechia and palpable purpura. Hemorrhagic macules may develop. The palms and soles are particularly affected. Extensive cutaneous necrosis occurs in a small percentage of patients experiencing gangrene of the extremities, necessitating amputation. Associated signs and symptoms include fever, severe headache, generalized myalgia, photophobia, nausea, and vomiting. Late in the course of the illness, shock and death may occur.
Septicemia
Thrombocytopenia or the effects of toxins in acute infection can lead to purpura, especially in the form of petechiae. Associated findings include fever, chills, headache, tachycardia, lethargy, diaphoresis, and anorexia. Signs and symptoms specific to the area of infection — for example, cough, wound drainage, and urinary burning — also occur.
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is a chronic inflammatory disorder that may produce purpura accompanied by other cutaneous findings, such as scaly patches on the scalp, face, neck, and arms; diffuse alopecia; telangiectasia; urticaria; and ulceration. The characteristic “butterfly rash” appears in the disorder’s acute phase. Common associated signs and symptoms include nondeforming joint pain and stiffness, Raynaud’s phenomenon, seizures, psychotic behavior, photosensitivity, fever, anorexia, weight loss, and lymphadenopathy.
Trauma
Traumatic injury can cause local or widespread purpura. Specific signs and symptoms depend on the type and location of the trauma.
Other causes
Diagnostic tests
Invasive procedures, such as venipuncture and arterial catheterization, may produce local ecchymoses and hematomas caused by extravasated blood.
Drugs
The anticoagulants heparin and warfarin can produce purpura. Administration of warfarin can result in painful areas of erythema that become purpuric then necrotic with an adherent black eschar. The lesions develop between the 3rd and 10th day of drug administration.
Surgery and other procedures
Any procedure that disrupts circulation, coagulation, or platelet activity or production can cause purpura. Such procedures include pulmonary and cardiac surgery, radiation therapy, chemotherapy, hemodialysis, multiple blood transfusions with platelet-poor blood, and use of plasma expanders such as dextran.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Purpura and Bleeding:
Principal Causes of Purpura and Bleeding
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Lossof vascular integrity
- Trauma
- Infection
- Henoch-Schönlein purpura
- Drugs
- Langerhans histiocytosis
- Ehlers-Danlos syndrome
- Vitamin C deficiency
- Hereditary hemorrhagic telangiectasia(Osler-Rendu-Weber disease)
- Thrombocytopenia
- Increasedplatelet destruction
- Immune-mediated
- Neonatal alloimmune thrombocytopenia
- Maternal autoimmune thrombocytopenia
- Idiopathic thrombocytopenic purpura
- Collagen vascular disease
- Drug-induced thrombocytopenia
- Infection
- Hemolytic-uremic syndrome
- Thrombotic thrombocytopenic purpura
- Wiskott-Aldrich syndrome
- Decreased platelet production
- Infection
- Specific platelet disorders
- Congenitalamegakaryocytic thrombocytopenia
- Thrombocytopenia–absent radiisyndrome
- Bone marrow suppression (generalized)
- Bone marrow replacement
- Megaloblastic anemia
- Platelet sequestration
- Hypersplenism
- Large hemangiomas
- Abnormal platelet function
- Thrombasthenia(Glanzmann disease)
- Giant platelet syndrome (Bernard-Souliersyndrome)
- Storage pool deficiency
- Drugs
- Uremia
- Coagulation disorders
- Factordeficiencies
- VonWillebrand disease
- Factor VIII deficiency (hemophiliaA)
- Factor IX deficiency (hemophilia B,Christmas disease)
- Deficiencies of Factors I, II, V, VII,X, XI, and XIII
- Vitamin K deficiency
- Disseminated intravascular coagulation
- Liver disease
- Circulating anticoagulants
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Purpura:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Autoerythrocyte sensitivity.With autoerythrocyte sensitivity, painful ecchymoses appear either singly or in groups, usually preceded by local itching, burning, or pain. Common associated findings include epistaxis, hematuria, hematemesis, and menometrorrhagia. Abdominal pain, diarrhea, nausea, vomiting, syncope, headache, and chest pain are also common.
Disseminated intravascular coagulation (DIC).DIC can cause varying degrees of purpura, depending on its severity and underlying cause. Rarely, the patient develops life-threatening purpura fulminans, with symmetrical cutaneous and subcutaneous lesions on the arms and legs. Or, he may have cutaneous oozing, hematemesis, or bleeding from incision or needle insertion sites. Other findings include acrocyanosis; nausea; dyspnea; seizures; severe muscle, back, and abdominal pain; and signs of acute tubular necrosis such as oliguria.
Dysproteinemias.With multiple myeloma,petechiae and ecchymoses accompany other bleeding tendencies: hematemesis, epistaxis, gum bleeding, and excessive bleeding after surgery. Similar findings occur with cryoglobulinemia, which may also produce malignant maculopapular purpura. Hyperglobulinemiatypically begins insidiously with occasional outbreaks of purpura over the lower legs and feet. These outbreaks eventually become more frequent and extensive, involving the entire lower leg and possibly the trunk. The purpura usually occurs after prolonged standing or exercise and may be heralded by skin burning or stinging. Leg edema, knee or ankle pain, and a low-grade fever may precede or accompany the purpura, which gradually fades over 1 or 2 weeks. Persistent pigmentation develops after repeated outbreaks.
Ehlers-Danlos syndrome (EDS).Besides petechiae, EDS is marked by easy bruising, epistaxis, gum bleeding, hematuria, melena, menorrhagia, and excessive bleeding after surgery. EDS characteristically produces soft, velvety, hyperelastic skin; hyperextensible joints; increased skin and blood vessel fragility; and repeated dislocations of the temporomandibular joint.
Idiopathic thrombocytopenic purpura (ITP).Chronic ITP typically begins insidiously, with scattered petechiae that are usually found on the distal arms and legs. Deep-lying ecchymoses may also occur. Other findings include epistaxis, easy bruising, hematuria, hematemesis, and menorrhagia.
Leukemia.Leukemia produces widespread petechiae on the skin, mucous membranes, retina, and serosal surfaces that persist throughout the course of the disease. Confluent ecchymoses are uncommon. The patient may also exhibit swollen and bleeding gums, epistaxis, and other bleeding tendencies. Lymphadenopathy and splenomegaly are common.
Acute leukemias also produce severe prostration and a high fever and may cause dyspnea, tachycardia, palpitations, and abdominal or bone pain. Confusion, headache, seizures, vomiting, papilledema, and nuchal rigidity may occur late in the disease. Chronic leukemiasbegin insidiously with minor bleeding tendencies, malaise, fatigue, pallor, a low-grade fever, anorexia, and weight loss.
Myeloproliferative disorders.Myeloproliferativedisorders, which include polycythemia vera, paradoxically can cause hemorrhage accompanied by ecchymoses and ruddy cyanosis. The oral mucosa takes on a deep purplish red hue, and slight trauma causes swollen gums to bleed. Other findings include pruritus, urticaria, and such nonspecific signs and symptoms as lethargy, weakness, fatigue, and weight loss. The patient typically complains of a headache, a sensation of fullness in the head, and rushing in the ears; dizziness and vertigo; dyspnea; paresthesia of the fingers; double or blurred vision and scotoma; and epigastric distress. He may also experience intermittent claudication, hypertension, hepatosplenomegaly, and impaired mentation.
Systemic lupus erythematosus (SLE).SLE may produce purpura accompanied by other cutaneous findings, such as scaly patches on the scalp, face, neck, and arms; diffuse alopecia; telangiectasia; urticaria; and ulceration. The characteristic butterfly rash appears in the disorder's acute phase. Common associated signs and symptoms include nondeforming joint pain and stiffness, Raynaud's phenomenon, seizures, psychotic behavior, photosensitivity, fever, anorexia, weight loss, and lymphadenopathy.
Thrombotic thrombocytopenic purpura.Generalized purpura, hematuria, vaginal bleeding, jaundice, and pallor are among the usual presenting signs and symptoms in thrombotic thrombocytopenic purpura. Most patients have fever, and some also experience fatigue, weakness, headache, nausea, abdominal pain, arthralgia, and hepatosplenomegaly. Possible neurologic effects include seizures, paresthesia, cranial nerve palsies, vertigo, and an altered level of consciousness. Renal failure may also occur.
Trauma.Traumatic injury can cause local or widespread purpura.
Other causes
Diagnostic tests.Invasive procedures, such as venipuncture and arterial catheterization, may produce local ecchymoses and hematomas due to extravasated blood.
Drugs.The anticoagulants heparin and warfarin can produce purpura.
Surgery and other procedures.Any procedure that disrupts circulation, coagulation, or platelet activity or production can cause purpura. These include pulmonary and cardiac surgery, radiation therapy, chemotherapy, hemodialysis, multiple blood transfusions with platelet-poor blood, and the use of plasma expanders such as dextran.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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