purpura

 Purpura

Purpura is bleeding disorder characterized by petechiae and ecchymosis which may be due to either deficiency in number or quality of platelets or defect in vascular endothelium.

Purpura occurs due to bleeding from capillaries under the skin.

Types of Purpura

1. Idiopathic thrombocytopenia purpura (ITP)

2. Anaphylactoid purpura (AP)

Idiopathic thrombocytopenia purpura (ITP)

Autoimmune response of body.

Most common acquired thrombocytopenic disorder in children is hemorrhagic condition involving skin, mucus membrane and internal organs.

Pathophysiology

Platelet formed from megakaryocytes in bone marrow.

Due to autoimmune causes, formed antibodies against platelets

Antibodies destroy platelets leading to platelet deficiency

Clinical manifestation

1. Petechiae

2. Ecchymosis

3. Bleeding from gums

4. Epistaxis

5. Anemia

6. Bleeding in joints

7. Low grade fever

8. Internal hemorrhage

9. Intracranial or intracerebral hemorrhage (if platelets low below 5000 cells/mm3).

Diagnostic Evaluation

1. Platelet count

2. Bleeding time and clotting time

3. Peripheral blood smear

4. Bone marrow examination

Management

1. Steroids

Suppress immune system

In emergency, infusion of dexamethasone or methyl prednisolone used. 

2. Anti D Antibodies

Treatment for Rh-positive patients is use of Anti D immunoglobulin; given intravenously.

3. Steroid sparing agents

Immunosuppressants; azathioprine, mofetil

4. Immunoglobulin

Intravenous immunoglobulins infuses

5. Platelet infusion

2. Anaphylactoid purpura

Also known as Schonlein-Henoch vasculitis. It is systemic inflammatory disorder causing inflammation and bleeding in small blood vessel,  characterized by deposition of immune complexes containing antibody IgA.

Etiology

1. Hypersensitive immunologic reaction to Group- A streptococcus resulting in vascular damage.

2. Bacterial or viral infection

3. Insect bite

4. Drugs; penicillin, aspirin

5. Foods; milk, egg

Clinical features

1. Erythematous petechiae rashes

2. Gastrointestinal symptoms;

Colicky abdominal pain

Vomiting

3. Renal manifestation

1. Hematuria

2. Proteinuria

3. Hypertension

Diagnostic Evaluation

Diagnosed based on;

1. Skin, joint and kidney findings

2. Throat culture

3. Urinalysis

4. Blood test

5. Renal function test

Management

1. Antibiotics administered

2. Short term steroid therapy

Prednisolone; relieve joint and abdominal pain.

3. Analgesics; acetaminophen; given for pain relief

Nursing Management

1. Provide safe environment

2. Control bleeding

3. Administed prescribed drugs