Petechiae, Purpura and Vasculitis Flashcards Preview

Rheum/Musculoskeletal/Derm Week 3 > Petechiae, Purpura and Vasculitis > Flashcards

Flashcards in Petechiae, Purpura and Vasculitis Deck (33):
1

What are the main types of purpura?

1) Macular/non-palpable purpura (generally non-inflammatory)

2) palpable purpura (sign of vasculitis)

 

These are NON blanchable

2

What kind of purpura is this?

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Petechiae (not blanchable)- small (less than 3mm) usually found in the 'dependent' areas of the body (legs when standing, back/butt when lying down in a hospital bed)

generally painless

3

What are the main causes of petechiae?

1) platelet related (low platelets or dysfunction)

2) non-platelet related (things that increase capillary fragility or allow them to leak)- sun damage can do this!!

*Petechiae are usually a sign of platelet dysfunction, and not a coagulation defect*

4

What are ecchymoses?

large (5+mm) non-palpable purpura that may or may not be painful or tender

5

While most petechiae are platelet related, ecchymoses are more likely to reflect what?

abnormalities in coagulation, rather than platelet defects (can result from hypercoag- OR hypocaguable states)

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6

What are some causes of purpura?

-thrombocytopenia or abnormal platelet function + infection/inflammation/trauma

poor dermal support + trauma (actinic damage, amyloid, Ehler's Danlos, scurvy)

Anticoagulant stage + trauma (DIC, vitamin K deficiency)

7

What is this?

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Solar purpura- chronic sun damage can cause bleeding

8

What is happening here?

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thrombocytopenia + trauma (linear purpura (=vibex))

9

What are the main causes of petechiae?

ABNORMAL PLATELET FUNCTION

-DIC and infection

-low platlets due to idiopathic, drug-induced, or autoimmune reasons

-inflammatory skin diseases

10

What are the main causes of ecchymoses?

COAGULATION DEFECTS

-DIC and infection

-trauma

-weak skin

-Waldenstrome hypergammaglobinemia 

11

What is happening here?

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Hypergammaglobulinemic Purpura of Waldenstrom

12

What is this?

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Henoch-Schonlein purpura (these are palpable- remember, unlike bland petechiae/ecchymosis, palpable purpura is assoicated with inflammation in blood vessels 

 

due to IgA deposition in vascular walls 

13

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14

How are vasculites categorized?

Primarily based on the size of the blood vessel involved

15

What are some diseases associated with small vessel vasculitis?

-Henoch Schonleion purpura (IgA vasculitis)

-Infections, drug reactions, maligancies and autoimmune disease

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16

What is this?

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Small vessel vasculitis

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17

What is this?

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Meningococcemia (acute)

18

What is this?

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Leukocytoclastic vasculitis 

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19

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20

What are some mixed size (small and medium vessel) vasculites?

ANCA assoicated vasculites (Churg-Strauss, Microscopic polyangiitis, Wegener's granulomatosis)

-Cyroglobulinemic vasculitis 

21

What is this?

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Churg-Strauss vasculitis 

22

What is a common medium vessel vasculitis?

Polyarteritis nodosa

23

What are some common large vessel vasculites?

-giant cell arteritis

-Takayasu arteritis

-Behcet's

24

Skin lesions depend on the size of the blood vessel involved. How do small vessel vasculities present?

These present as palpable purpura or blisters and rarely hives

25

How do medium vessel vasculities present?

Nodules, purpura, livedo retiuclaris/racemosa or

ulcers, skin necrosis 

 

NOTE: large vessel vasculities are less likely to affect skin

26

What is this?

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Henoch-Schonleion purpura

27

What does this show?

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IgA deposition in blood vessel wall in HSP

28

What is this?

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Polyarteritis nodosa causing deep nodules instead of palpable purpura

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29

What is retiform purpura?

A form of eccymosis with a netlike pattern resulting from vascular ischemia, usually due to an underlying thrombotic disorder

 

30

Widespread retiform purpura is called what?

purpura fulminans

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31

Palpable purpura =

vasculitis

32

Retiform purpura

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Pink spots down in the dermis are clots (caused by cutting cocaine with levamisole- a medication used to treat parasitic worm infections)

 

Levamisole can make a subset of people extremly hypercoaguable 

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33

What causes retiform purpura?

It is a pattern of purpura caused by a variety of insults that *disrupt blood flow to the skin*. Common causes:

congential coag defects, infection, cocaine cut with levamisole (if you see retiform purpura in someone that is ILL (with fever, etc.) you have to think meningococcemia)