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Purpura :Causes and initial workup

  • Purpura: A term used to describe purple-colored spots and patches on the skin, mucous membranes, or organs, resulting from the extravasation of blood.
  • Petechiae: Small, pinpoint (1-2 mm) purpuric lesions.
  • Ecchymoses: Larger purpuric lesions (greater than 1 cm).

Pathophysiology

Purpura, petechiae, and ecchymoses result from bleeding underneath the skin or mucous membranes. This can occur due to:

  • Vascular Causes: Damage or inflammation of blood vessels.
  • Platelet Disorders: Abnormalities in platelet number or function.
  • Coagulation Disorders: Defects in clotting factors.
  • Other Mechanisms: External trauma or increased venous pressure.


Causes of Purpura

Category Subcategory Causes Key Features
Vascular Disorders Vasculitis Henoch-Schönlein Purpura Palpable purpura, usually on the lower extremities, often associated with abdominal pain and renal involvement.
Vasculitis Leukocytoclastic Vasculitis Non-blanching red or purple spots, may be associated with systemic symptoms like fever.
Vasculitis Osler-Weber-Rendu (Hereditary Hemorrhagic Telangiectasia) Telangiectasias on skin, mucous membranes, and organs; recurrent nosebleeds; arteriovenous malformations.
Structural Abnormalities Ehlers-Danlos Syndrome Hyperextensible skin, joint hypermobility, and easy bruising.
Structural Abnormalities Senile Purpura Ecchymoses on the extensor surfaces of forearms and hands, skin fragility in elderly patients.
Deficiency Scurvy (Vitamin C deficiency) Perifollicular hemorrhages, gingival bleeding, and coiled hair.
Platelet Disorders Thrombocytopenia Immune Thrombocytopenic...

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