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Bruising of the Lower Limb

 
 
 
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On this page:Purpura

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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