STUDY - Technical - New Dacian's Medicine
Purpura
(Classical / Allopathic Medicine)
Purpura
is the extravasation of red blood cells from the blood
vessels into the skin, subcutaneous tissue, or mucous
membranes. It's characterized by discoloration - usually
purplish or brownish-red - that's easily visible through
the epidermis. Purpuric lesions include petechiae,
ecchymoses, and hematomas. (See Identifying purpuric
lesions.) Purpura differs from erythema in that it doesn't
blanch with pressure because it involves blood in the
tissues, not just dilated vessels.
Purpura
can result from damage to the endothelium of small blood
vessels, a coagulation defect, ineffective perivascular
support, capillary fragility, permeability, or a
combination of these factors. These faulty hemostatic
factors, in turn, can result from thrombocytopenia or
another hematologic disorder, an invasive procedure, or
the use of an anticoagulant.
Additional
causes are nonpathologic. Purpura can be a consequence of
aging when loss of collagen decreases connective tissue
support of upper skin blood vessels. In the elderly or
cachectic person, skin atrophy and inelasticity, and loss
of subcutaneous fat increase susceptibility to minor
trauma, causing purpura to appear along the veins of the
forearms, hands, legs, and feet. Prolonged coughing or
vomiting can produce crops of petechiae in the loose face
and neck tissue. Violent muscle contraction - for example,
in seizures or weight lifting - sometimes results in
localized ecchymoses from increased intraluminal pressure
and rupture. High fever, which increases capillary
fragility, can also produce purpura.
Identifying
purpuric lesions
Purpuric lesions fall into three categories: petechiae, ecchymoses, and hematomas.
Petechiae
Petechiae are painless, round, pinpoint lesions, 1 to 3 mm in diameter. Caused by the extravasation of red blood cells into cutaneous tissue, these red or brown lesions usually arise on dependent portions of the body. They appear and fade in crops and can group to form ecchymoses.
Ecchymoses
Ecchymoses, another form of blood extravasation, are larger than petechiae. These purple, blue, or yellow-green bruises vary in size and shape and can arise anywhere on the body as a result of trauma. Ecchymoses usually appear on the arms and legs of patients with a bleeding disorder.
Hematomas
Hematomas are palpable ecchymoses that are painful and swollen. Usually the result of trauma, superficial hematomas are red, whereas deep hematomas are blue. Many hematomas exceed 1 cm in diameter, but their size varies widely.
HISTORY:
Ask the patient when he first noticed the lesion and whether he has noticed other lesions on his body.
Ask the patient if he has any known allergies. If so, ask him if he's recently been exposed to them.
Ask the patient if he or his family has a history of bleeding disorders or easy bruising.
Ask the patient about recent trauma or transfusions and the development of associated signs, such as epistaxis, bleeding gums, hematuria, vaginal bleeding, and hematochezia. If the patient is female, ask about heavy menstrual flow.
Ask the patient about systemic complaints such as a fever that may suggest infection.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Purpuric lesions fall into three categories: petechiae, ecchymoses, and hematomas.
Petechiae
Petechiae are painless, round, pinpoint lesions, 1 to 3 mm in diameter. Caused by the extravasation of red blood cells into cutaneous tissue, these red or brown lesions usually arise on dependent portions of the body. They appear and fade in crops and can group to form ecchymoses.
Ecchymoses
Ecchymoses, another form of blood extravasation, are larger than petechiae. These purple, blue, or yellow-green bruises vary in size and shape and can arise anywhere on the body as a result of trauma. Ecchymoses usually appear on the arms and legs of patients with a bleeding disorder.
Hematomas
Hematomas are palpable ecchymoses that are painful and swollen. Usually the result of trauma, superficial hematomas are red, whereas deep hematomas are blue. Many hematomas exceed 1 cm in diameter, but their size varies widely.
HISTORY:
Ask the patient when he first noticed the lesion and whether he has noticed other lesions on his body.
Ask the patient if he has any known allergies. If so, ask him if he's recently been exposed to them.
Ask the patient if he or his family has a history of bleeding disorders or easy bruising.
Ask the patient about recent trauma or transfusions and the development of associated signs, such as epistaxis, bleeding gums, hematuria, vaginal bleeding, and hematochezia. If the patient is female, ask about heavy menstrual flow.
Ask the patient about systemic complaints such as a fever that may suggest infection.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Inspect the patient's entire skin surface to determine the type, size, location, distribution, and severity of purpuric lesions.
Inspect the mucous membranes.
Inspect the patient's entire skin surface to determine the type, size, location, distribution, and severity of purpuric lesions.
Inspect the mucous membranes.
SPECIAL
CONSIDERATIONS:
Procedures that disrupt circulation, coagulation, or platelet activity or production may cause purpura.
Procedures that disrupt circulation, coagulation, or platelet activity or production may cause purpura.
PEDIATRIC
POINTERS:
Causes of purpura in infants include thrombocytopenia, vitamin K deficiency, and infantile scurvy.
The most common type of purpura in children is allergic purpura. Others include trauma, hemophilia, autoimmune hemolytic anemia, Gaucher's disease, thrombasthenia, congenital factor deficiencies, Wiskott-Aldrich syndrome, acute idiopathic thrombocytopenic purpura, von Willebrand's disease, and the rare but life-threatening purpura fulminans, which usually follows a bacterial or viral infection.
When you assess a child with purpura, be alert for signs of possible child abuse.
Causes of purpura in infants include thrombocytopenia, vitamin K deficiency, and infantile scurvy.
The most common type of purpura in children is allergic purpura. Others include trauma, hemophilia, autoimmune hemolytic anemia, Gaucher's disease, thrombasthenia, congenital factor deficiencies, Wiskott-Aldrich syndrome, acute idiopathic thrombocytopenic purpura, von Willebrand's disease, and the rare but life-threatening purpura fulminans, which usually follows a bacterial or viral infection.
When you assess a child with purpura, be alert for signs of possible child abuse.
PATIENT
COUNSELING:
Tell the patient with purpura not to use cosmetic fade creams or other products in an attempt to reduce pigmentation. Reassure him that purpuric lesions aren't permanent and will fade if the underlying cause can be successfully treated.
Tell the patient with purpura not to use cosmetic fade creams or other products in an attempt to reduce pigmentation. Reassure him that purpuric lesions aren't permanent and will fade if the underlying cause can be successfully treated.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.