What is purpura?
Essentially "blood under the skin"
- non-blanchable, pink to purple macules/patches or papules caused by extravasated RBC's in skin or mucous membranes
3 Main causes of purpura?
- coagulation/clotting abnormalities
- leaky or abnormal blood vessels
- other causes, including trauma
2 types of purpura? Which is associated with inflammation? Inflammatory purpura is a sign for what?
- non-palpable/macular (NON inflammatory)
- palable (inflammatory) = signs of vasculitis
2 types of non-palpable purpura?
What type of non-palpable purpura is this?
Painful or painless?
- small <3 mm red or purple dots
- usually on dependent areas of body
- generally painless
Who is most likely to have petechiae (2 types of pts)?
pt with hemophilia or with cancer receiving chemotherapy
Petechiae is generally considered to be an abnormality in what?
Non-platelet related petechiae is usually due to what?
things that increase capillary fragility or allow them to leak
What was the dx of this type of petechiae?
Scurvy, due to vit C defiency
- petechiae associated with hair follicles, hair is curled
Non-scientific name for ecchymosis?
Location on body?
Painful or painless?
- Larger areas of purpura (>5mm)
- can be anywhere on body
- may/may not be painful, tender
Ecchymosis are usually due to what?
Coagulation defect (hyper or hypocoaguable)
Purpura is multifactorial.
Just know it.
Palpable purpura is a hallmark for ?
Leukocytoclastic vasculitis (this will be on the test. i guarantee it)
What is this type of purpura Dr. S talked about? What immunoglobulin is it associated with?
HSP (Henoch-Schonlein purpura),
Associated with IgA (shown in clumps on IF)
Unlike bland petechiae/ecchymosis, palpable purpura is assocaited with what?
Inflammation in blood vessels (aka vasculitis)
Remember, where are blood vessels found?
Dermis/ Subq. not in epidermis
Vasculitis classified based on?
Size of vessel involved (small, mixed small/medium, medium, large vessel vasculitis)
Vasculitis is more predominantly seen in where geographically on body?
- Lower extremities (in ambulatory patients)
- Ass cheeks in bed-ridden patients
List features of small vessel vasculitis
blisters, less commonly hives (like urticarial vasculitis)
List features of medium vessel vasculitis
- Nodules, purpura, livedo reticularis/racemosa
- Ulcers, skin necrosis
List features of large vessel vasculitis
Less likely to affect skin
List diseases with small vessel vasculitis?
HSP, infections, Drug reactions, autoimmune diseases, malignancy associated vasculitis, Idiopathic
Name some mixed (small/medium) vasculitis?
ANCA associated vasculitis (Churg-strauss, Microscopic polyangiitis, Wegner's granulomatosis)
Disease associated with medium vessel vasculitis?
Diseases of large vessel vasculitis?
Giant cell arteritis, takayasu arteritis, Behcet's
Based on your understanding of how small, medium, and large vessel vasculitis present. Which type is this? Bonus points. Name that dx?
Churg-Strauss (small/medium vessel vasculitis)
- not much palpable purpura, more nodules
What do you call this pattern seen on skin? Associated with what disease/size of vessel involvement?
This is livedo reticularis, seen in polyarteritis nodosa (medium vessel vasculitis)
Name this. A distinctive form of ecchymosis with a "net-like" pattern
Worst kind of purpura to have.
Retiform purpura results from what?
Vascular ischemia, usually due to an underlying thrombotic disorder
This type of retiform purpura is known as? aka?
Purpura fulminans (DIC)
Street drug associated with DIC?
Shitty cocaine. Key word: shitty
Retiform pupura + fever. Most worrisome diagnosis?
Meningococcemia (wear gloves/mask)