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Haem Exam

 
 
 
The Patient
The Hands
The Arms
The Face
The Neck
The Chest
The Abdomen
The Pelvis
The Back
The Legs
 
 

Bruising

 
 

Purpura

    • Look For
    • Red / purple lesions that do not blanch with pressure. May be present over the head, arms, legs, chest or abdomen.
    • Significance
    • Liver disease can result in purpura due to both clotting factor deficiency (intrahepatic) and vitamin K malabsorption (obstructive).
    • Causes of Purpura
    • Trauma
    • Platelet Disorders
    • Idiopathic thrombocytopaenic purpura (ITP)
    • Thrombotic thrombocytopaenic purpura (TTP)
    • Disseminated intravascular coagulation (DIC)
    • Bone marrow failure - aplastic anaemia, leukaemia, chemotherapy
    • Platelet sequestration - splenomegaly, haemangioma
    • Haemolytic-uraemic syndrome
    • Disorders of Coagulation
    • Factor deficiencies - haemophilia, Von Willebrand disease
    • Vitamin K deficiency - malabsorption, poor diet
    • Anticoagulants
    • Vascular Disorders
    • Connective tissue diseases - Ehlers-Danlos, scurvy
    • Infection - mengingococcal, streptococcal, viral
    • Henoch-Schönlein purpura
    • Senile purpura
    • Steroids
    • Interpretation
    • Petechiae - flat lesions, <4mmThrombocytopaenia / abnormal platelet function, DIC
    • Ecchymoses - flat lesions, >4mmTrauma, DIC, coagulation disorders, senile purpura
    • Palpable purpura associated with arthralgia, abdominal pain and renal diseaseHenoch-Schönlein purpura
 
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