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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