Heme and Lymph Flashcards
(39 cards)
non blanchable, hemorrhagic skin lesions that result from leakage of RBCs into skin
purpura
macular purpura
non palpable/ non-inflammatory
petechiae if under 3 mm
ecchymosis if over 5 mm
purpura + thrombocytopenia and abnormal coagulation studies
septicemia HUS Leukemia ITP coagulpathies (hemophilia)
SHLIC
are purpura palpable in thrombocytopenic purpuric disorders
no
purpura + normal platelet count and coagulation studies
henosch-schoenlein purpura (HSP or IgA vasculitis)
common in children with HSP but not in adults
intussesception
tetrad for HSP is
palpable purpura without thrombocytopenia and coagulopathy
\+ 1 or more of the following -acute arthralgia and or arthritis acute abdominal pain renal disease IgA depostion on biopsy
immune mediated vasculitis that may be triggered by a variety of antigens including various infections and immunizations
IgA vasculitis (IgA nephropathy)
considerations for diagnosis of HSP:
may follow ____ infection and present with generalized what
strep
arthralgias/myalgias, rash, palpable purpura (especially on LE and buttocks) abdominal pain, and renal insufficiency
PAM RARI
acute hemorrhagic edema of infancy
called what else what age extent of disease presents with biopsy
leukocytoclastic vasculitis
children btwn ages of 4 months to two years
self limited disease, resolves in 1-3 weeks
fever, purpura, ecchymosis, inflammatory edema of limbs (FEPI)
biopsy demonstrates leukocytoclastic vasculitis with occasional IgA deposition
hypersensitivity vasculitis
from what
symptoms
histopath
inflammation of the small vessels that occurs after exposure to:
drugs, infection, or without known tigger
fever, urticaria, LAD, arthralgias (no GN)
histopathology: leukocytoclastic vasculitis primarily of postcap venules, but IgA deposition is absent
other small vessel vasculitieds: primary vasculitieds
granulomatosis with polyangiitis (wegner)
microscopic polyangiitis
eosinophilic granulomatosis with polyangiitis (churg strauss syndrome)
secondary vascular inflammation
SLE
RA
infectious disease (hepatitis)
uncommon in children
pt doing insanity workout with arthralgias, abdominal pain, renal insufficiency, cpk elevation
rhabdomyolysis
until pt develops the classical purpura of HSP could have DDx of
arthritis and arthralgia
rheumatic fever vs HSP
evidence of recent gropu A beta hemolytic strep infection
+ clincial course of Jones criteria: rash diff, erythema marginatum, nodules and carditis
possible history of recent strep + clinical course of HSP tetrad then
HSP
septic and toxic synovitis aka transient synovitis
joint symptoms similar to those seen in pts with HSP
only one or two joints, unlike polyarthritis seen in HSP
-affected joints are warm and erythematous in septic arthritis, unlike hsp
reactive arthritis trigger
variety of GU or GI pathogens like b-hemolytic strep
differentiating acute abdominal emergency from HSP before purpura develops
rash of HSP usually precedes GI manifestations and seldom lags b more than few days
managment of HSP
vast majorit of pts recover spontaneously thus care is primarily supportive
what do you need to assess in HSP
renal status, overall fluid/electrolyte status
in severe cases, corticosteroids have been used (only when absolutley need them)
what is impiric to give in HSP
IV hydration (saline/D5/LR)
other drugs for HSP
pain managment (possible NSAIDs)
anti-emetics for N/V
PPI for acute gastritis/PUD from NSAID or steroids
acute abdominal series (xray) or US to screen for intussusception
