Hematology and Oncology Book

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Purpura

Aka: Purpura, Purpuric rash, Petechiae, Ecchymosis, Ecchymoses
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  1. See Also
    1. Purpura Causes
  2. Definitions
    1. General: Non-blanching cutaneous Hemorrhages
    2. Petechiae: Pinpoint Hemorrhages <2 mm in diameter
    3. Purpura: 2 to 10 mm in diameter
    4. Ecchymosis: >10 mm in diameter
  3. Signs: Purpura
    1. Visible non-blanching Hemorrhages
    2. Occurs in the skin or mucus membranes
    3. Size: 2-10 mm in diameter (see definitions above)
    4. Palpable Purpura suggests Vasculitis
    5. Purpura on Lower extremities
      1. Henoch-Schonlein Purpura
    6. Purpura on palms and soles
      1. Rickettsial infection
  4. Signs: Associated Conditions
    1. Hypertension
      1. Chronic Renal Failure
      2. Renal Vasculitis
    2. Hemarthrosis
      1. Hemophilia
    3. Skeletal abnormalities
      1. Thrombocytopenia-absent radii (TAR syndrome)
      2. Fanconi's Anemia (Short Stature)
    4. Skin hyperelasticity and joint hypermobility
      1. Ehlers-Danlos Syndrome
    5. Telangiectases
      1. Hereditary Hemorrhagic Telangiectasia
      2. Liver disease
  5. Labs: Complete Blood Count and Peripheral Smear
    1. Schistocytes
      1. Hemolytic-Uremic Syndrome
      2. Thrombotic Thrombocytopenic Purpura
      3. Disseminated Intravascular Coagulopathy
    2. Atypical Lymphocytosis
      1. Infectious Mononucleosis
      2. Cytomegalovirus
      3. Leukemia blast cells with similar appearance
    3. Reticulocyte Count increased
      1. Hemolytic Anemia
  6. Labs: Platelet Count and Indices
    1. Anemia and Thrombocytopenia
      1. Leukemia
      2. Systemic Lupus Erythematosus
      3. Aplastic Anemia
    2. Thrombocytopenia with otherwise normal CBC
      1. Idiopathic Thrombocytopenic Purpura
    3. Altered platelet size
      1. See Mean Platelet Volume (MPV)
  7. Labs: Urinalysis with Hematuria
    1. Henoch-Schonlein Purpura
    2. Systemic Lupus Erythematosus
    3. Hemolytic-Uremic Syndrome
  8. Causes
    1. See Purpura Causes
  9. Approach: Children - Step 1 (non-bleeding cause)
    1. If unable to identify cause, go to step 2 below
    2. Identify potential cause based on history and exam
      1. See Purpura Causes
      2. See Signs above
  10. Approach: Children - Step 2 (bleeding cause)
    1. Obtain Bleeding Disorder lab-work
      1. Complete Blood Count (CBC) with Platelet Count
      2. Peripheral Blood Smear
      3. ProTime
      4. Activated Partial Thromboplastin Time (aPTT)
    2. Evaluate Platelet Count
      1. Platelet Count low: Go to Step 3a below
      2. Platelet Count normal: Go to Step 3b below
  11. Approach: Children - Step 3a (Low Platelet Count)
    1. See Thrombocytopenia
    2. Prothrombin Time and aPTT prolonged
      1. Sepsis
      2. Disseminated Intravascular Coagulopathy
    3. Prothrombin Time and aPTT not prolonged
      1. Idiopathic Thrombocytopenic Purpura
      2. Hemolytic-Uremic Syndrome
      3. Thrombotic Thrombocytopenic Purpura
      4. Systemic Lupus Erythematosus
      5. Bone Marrow aplasia
      6. Platelet Sequestration
  12. Approach: Children - Step 3b (Normal Platelet Count)
    1. Prothrombin Time and aPTT prolonged
      1. Coagulation Factor deficiency
      2. Von Willebrand's Disease
      3. Circulating Anticoagulant
      4. Liver disease
    2. Prothrombin Time and aPTT not prolonged
      1. Go to Step 4 below
  13. Approach: Children - Step 4 (Bleeding Time)
    1. Obtain Bleeding Time
    2. Bleeding Time prolonged
      1. See Platelet Dysfunction
      2. Von Willebrand's Disease
    3. Bleeding Time normal
      1. Child Abuse
      2. Von Willebrand's Disease
      3. Vascular Purpura
  14. Precautions: Patients with bleeding tendency
    1. See Thrombocytopenia for activity and procedure limitations based on Platelet Count
    2. Caution with strenuous activity or contact sport
    3. Caution with Intramuscular Injections
    4. Avoid Aspirin and NSAIDs
  15. References
    1. Baselga (1997) J Am Acad Dermatol 37:673-705
    2. Leung (2001) Am Fam Physician 64(3): 419-28
    3. Stevens (1995) Am Fam Physician 52(5):1355-62

Ecchymosis (C0013491)

Definition (MSH) Extravasation of blood into the skin, resulting in a nonelevated, rounded or irregular, blue or purplish patch, larger than a petechia.
Definition (NCI) A small bruise caused by blood leaking from broken blood vessels into the tissues of the skin or mucous membranes.
Concepts Finding (T033)
MSH D004438
SnomedCT 77643000, 302227002
English ECCHYMOSIS, ecchymosis, ecchymosis (physical finding), ecchymoses, Ecchymosis NOS, Ecchymosis [Disease/Finding], ecchymosi, ecchymose, Ecchymoses, Ecchymosis (finding), Ecchymosis (morphologic abnormality), Ecchymosis
Spanish EQUIMOSIS, Equimosis NEOM, equimosis (anomalía morfológica), equimosis (hallazgo), equimosis, Equimosis
Dutch ecchymosen, ecchymose NAO, ecchymose, Ecchymose
French Ecchymoses, Ecchymose SAI, MEURTRISSURES ECCHYMOTIQUES, Ecchymose, Bleu
German Ekchymose NNB, Ekchymosen, EKCHYMOSIS, Ekchymose
Italian Ecchimosi NAS, Macchie emorragiche, Ecchimosi
Portuguese Equimose NE, Equimoses, EQUIMOSES, Equimose
Japanese 斑状出血ＮＯＳ, 斑状出血, ﾊﾝｼﾞｮｳｼｭｯｹﾂ, ﾊﾝｼﾞｮｳｼｭｯｹﾂNOS
Swedish Blodutgjutning
Czech ekchymóza, Ekchymóza, Ekchymózy, Ekchymóza NOS
Finnish Mustelma
Russian EKKHIMOZ, ЭКХИМОЗ
Polish Siniaki, Wybroczyny krwawe
Hungarian Ecchymosis k.m.n., Ecchymosis, Ecchymosisok
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Petechiae (C0031256)

Definition (NCI) Purple or red pinpoint spots in the skin or mucous membranes caused by minor hemorrhage.
Definition (MSH) Pinhead size (3 mm) skin discolorization due to hemorrhage.
Definition (CHV) Pinpoint, unraised, round red spots under the skin caused by bleeding
Definition (CHV) Pinpoint, unraised, round red spots under the skin caused by bleeding
Definition (CHV) Pinpoint, unraised, round red spots under the skin caused by bleeding
Definition (CHV) Pinpoint, unraised, round red spots under the skin caused by bleeding
Definition (NCI) Pinpoint, unraised, round red spots under the skin caused by bleeding.
Concepts Disease or Syndrome (T047)
MSH D011693
ICD10 R23.3
SnomedCT 206906004, 271813007, 423716004, 141618008, 164431004, 158259006, 50091001
English Hemorrhage, petechial, PETECHIAL RASH, PETECHIA, PETECHIAE, RASH PETECHIAL, [D]Petechiae, [D]Petechiae (context-dependent category), Petechiae (finding), Petechiae of skin (disorder), Petechiae (disorder), Petechiae of skin, petechial hemorrhages, petechial hemorrhages (___cm), petechial hemorrhages (physical finding), [D]Petechiae (situation), petechiae (diagnosis), petechiae, Rash petechial, petechial rash, petechial hemorrhage, Petechia, Petechial hemorrhage, Petechial haemorrhage, Petechial eruption, Petechial rash, Petechia (morphologic abnormality), petechia, Petechiae, hemorrhage; petechial, petechial; hemorrhage
Italian Petecchie, Petecchia, Esantema petecchiale, Eruzione petecchiale
Dutch petechiën rash, petechie, rash met petechiën, petechiae, bloeding; petechiaal, petechiaal; bloeding, Petechiae
French Rash pétéchial, Pétéchies, ERUPTION PETECHIQUE, PETECHIES, Pétéchie
German Petechie, Ausschlag petechienartig, petechienartiger Ausschlag, Petechien, AUSSCHLAG PETECHIAL, PETECHIEN
Portuguese Petéquia, Exantema petequial, Erupção petequial, Petequia, ERUPCAO DE PETEQUIAS, PETEQUIAS, Petéquias
Spanish Erupción petequial, [D]petequias (categoría dependiente del contexto), petequias cutáneas, petequias cutáneas (trastorno), petequias (trastorno), petequias (hallazgo), Petechiae, [D]Petechiae, Petequia, ERUPCION PETEQUIAL, PETEQUIAS, [D]petequias, [D]petequias (situación), erupción petequial, hemorragia petequial, petequia (anomalía morfológica), petequias, petequia, Petequias
Japanese 点状出血, 点状出血性皮疹, ﾃﾝｼﾞｮｳｼｭｯｹﾂｾｲﾋｼﾝ, ﾃﾝｼﾞｮｳｼｭｯｹﾂ
Czech Petechie, Vyrážka charakteru petechií
Hungarian Petechiák, Petechia, Petechiás kiütés, petechiás exanthema
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Purpura (C0034150)

Definition (NCI) A hemorrhagic area of the skin and mucous membrane. Newer lesions appear reddish in color. Older lesions are usually a darker purple color and eventually become a brownish-yellow color.
Definition (NCI) A disorder characterized by hemorrhagic areas of the skin and mucous membrane. Newer lesions appear reddish in color. Older lesions are usually a darker purple color and eventually become a brownish-yellow color.
Definition (MSH) Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. When the size of the discolorization is >2-3 cm it is generally called Ecchymoses (ECCHYMOSIS).
Definition (CSP) small hemorrhage in the skin, mucous membrane or serosal surface, or a group of hemorrhagic diseases characterized by purpuric lesions.
Concepts Disease or Syndrome (T047)
MSH D011693
ICD10 D69.2
SnomedCT 423902002, 191313005, 12393003, 387778001, 118653003, 154822006, 267564008, 246989006
English Purpuras, PURPURA, PURPURAS, Peliosis, NOS, Purpura, NOS, Purpura (finding), purpura, purpura (physical finding), C-62 PURPURAS, Purpura (disorder), purpura was seen, purpura (diagnosis), Purpura NOS, Purpura [Disease/Finding], purpuras, Peliosis, Disorder characterised by purpura, Disorder characterized by purpura, Purpura (morphologic abnormality), Purpuric disorder (disorder), Purpuric disorder, peliosis, Purpura
French PURPURA, Purpura SAI, Péliose, Purpura
Portuguese PURPURA, Peliose, Púrpura NE, Púrpura, Purpura
Spanish PURPURA, Peliosis, Púrpura NEOM, púrpura (hallazgo), Purpura, Simple bruising, Purpura simplex (disorder), enfermedad purpúrica (trastorno), enfermedad purpúrica, peliosis, púrpura (anomalía morfológica), púrpura, trastorno caracterizado por púrpura, trastorno purpúrico, Púrpura
German PURPURA, Peliosis, Purpura NNB, Purpura
Dutch purpura NAO, peliose, purpura, Purpura
Italian Peliosi, Porpora NAS, Porpora
Japanese 紫斑病, 紫斑ＮＯＳ, 紫斑, ｼﾊﾝNOS, ｼﾊﾝﾋﾞｮｳ, ｼﾊﾝ
Swedish Hudblödning
Czech purpura, Purpura, Purpura NOS, Pelióza
Finnish Purppura
Russian PURPURA, PETEKHII, ПЕТЕХИИ, ПУРПУРА
Croatian Not Translated[Purpura]
Polish Plamica
Hungarian Purpura, Purpura k.m.n., Peliosis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Purpuric rash (C0151882)

Concepts Disease or Syndrome (T047)
SnomedCT 284078000
English PURPURIC RASH, RASH PURPURIC, Purpuric rashes, RASH PURPITIC, Rash purpitic, Rash purpuric, purpuric rash, Purpuric rash (disorder), Purpuric rash
Dutch purpura
French Rash purpurique, Rash purpitique, ERUPTION PURPURIQUE
German Purpuraauschlag, Purpuraausschlag, AUSSCHLAG HAEMORRHAGISCH
Italian Esantema purpureo
Portuguese Exantema purpúrico, Erupção purpúrica, ERUPCAO PURPURICA
Spanish Erupción purpúrica, ERUPCION PURPURICA, erupción purpúrica (trastorno), erupción purpúrica
Japanese 紫斑性皮疹, ｼﾊﾝｾｲﾋｼﾝ
Czech Purpura
Hungarian exanthema purpurás, Kiütés purpurás, Purpurás kiütés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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