Petechiae

Idiopathic thrombocytic purpura (ITP) is the most common cause of petechiae in an otherwise well child. It is an autoimmune process which typically occurs about 4 weeks after a viral infection. The child will have sudden onset of generalized petechiae. Most cases resolve spontaneously, although 10–20% children with ITP may develop chronic ITP.

Differential Diagnosis

• Antibody-mediated
  –ITP
  –Immunologic disorders
  –Infection
• Coagulopathy
  –Disseminated intravascular coagulopathy
  –Sepsis
  –Necrotizing enterocolitis
  –Cavernous hemangioma (Kasabach-Merritt syndrome)
  • Congenital
    –Fanconi anemia: Pancytopenia usually does not occur until after age 5. Associated with short stature, hyperpigmentation, thumb anomalies, renal problems, and microcephaly; autosomal recessive
    –Wiskott-Aldrich syndrome: Immune defects with increased IgE and IgA, and decreased IgM; associated with eczema and thrombocytopenia; X-linked
    –Thrombocytopenia absent radii: Thrombocytopenia is most marked during the first year of life; autosomal recessive
    –May-Heglin anomaly: Giant platelets and leukocyte inclusions
    –Bernard-Soulier disease: Giant platelets
    –Glanzmann thrombocytopenia
    –Metabolic disorders
    –Osteopetrosis
  • Acquired decreased production
    –Leukemia or other malignancy
    –Aplastic anemia
    –Folate or vitamin B12 deficiency
  • Other causes
    –Hemolytic uremic syndrome
    –Thrombotic thrombocytopenic purpura
    –Drug-induced
    –Hypersplenism
    –Respiratory distress syndrome
    –Uremia
    –Progressive pigmentary dermatosis (Schamberg disease): Petechiae typically over the lower extremities

  Workup and Diagnosis

  • History
    –Age of the patient, recent state of health
    –Past medical history, medications, family history
    –Onset sudden or gradual, bleeding from mucous membranes, preceding viral infection, weight loss, appetite, night sweats, frequent emesis, tight tourniquet or blood pressure cuff
  • Physical exam
    –Vital signs, stability, temperature, blood pressure
    –General appearance (well- or ill-appearing)
    –Examine gums, nose, ears for signs of bleeding
    –Evaluate presence and location of petechiae, purpura, hemangiomas, and other skin findings such as eczema
    –Note lung sounds, presence or absence of cardiovascular hyperdynamic state; palpate spleen
  • Labs
    –CBC with differential to discover thrombocytopenia and determine whether other cell lines are involved
    –Bone marrow aspirate if thrombocytopenia cannot be explained by history or physical or if there is a worrisome history or involvement of other cell lines
  • Additional tests: Blood culture, peripheral smear, radiographic studies, U/A, ANA, HIV all may be useful depending on the history/physical

  Treatment

  • Idiopathic thrombocytic purpura
    –Most cases resolve spontaneously without treatment
    –IVIG or steroids are needed in the more severe cases where there is significant bleeding or platelet count is <10,000
    –RhoGam can be given to Rh+ xpatients as an option for patients who don’t respond to other therapies
  • Platelet transfusion is indicated for patients with low platelets where production is limited, destruction is not rapid, and platelet count is dangerously low, such as leukemia
  • Splenectomy may be an option if platelets are sequestered chronically
  >

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Ecchymosis

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Ecchymosis

• Back to symptom: Ecchymosis: Introduction (review 47 causes)
• Next Book Extract About Ecchymosis: Purpura (Handbook of Signs & Symptoms (Third Edition))
• All Book Extracts: All Online Book Extracts for Ecchymosis

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Purpura (Handbook of Signs & Symptoms (Third Edition))

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