Chapter 17- Purpura Flashcards
petechiae - purpuric maclues
Thrombocytompenic Purpura (TTP)
What is the most common cause of Thrombocytopenic Purpura (TTP)?
drugs
What age group does Thrombocytompenic Purprura effect? What are specific questions you would ask them?
Children & Adults
but for children with acute thrombocytopenic purport there is usually a history of a viral infection with the preceding 1-3 weeks.
What are the 7 cause of thrombocytopenic purpura?
- Drugs
- Viral infections
- Aids
- Collagen vascular disease
- Hematologic malignancy
- ITP
- TTP
thrombotic thrombocytopenic purpura (TTP) is usually accompanied by what?
fever, hemolytic anemia, and neurologic symptoms
_______ is frequently found in patients with hematologic malignancies or chronic ITP (idiopathic/immune thrombocytopenic purpura)
Splenomegaly
due to mucosal bleeding possibly being present with thrombocytopenic purpura, what should also be examined?
conjuctivae and oral cavity
petechial lesions of the lower legs due to weakened capillaries, causing leakage (but not enough to cause elevation of the lesion); looks like cayenne pepper.
Schamberg’s disease
in a patent with dermatitis, _____ could cause petechiae.
venous stasis
what lab should be done in a patient with petechiae?
complete blood cell count and platelet count.
platelet count <50 000/mm^3 occurs when there is bleeding from _____.
thrombocytopenia
a platelet count of <20 000/mm^3 results in bleeding from _____
minor trauma
a platelet count <10 000/mm^3 predisposes the patient to _____
internal bleeding
what can you do to distinguish non inflammatory petechiae from vasculitis, although the clinical picture is usually so distinctive its not required.
skin biopsy
where else can drug - induced throbmbocytopenia produce bleeding?
gastrointestinal tract*** KNOW THIS!
- if suspected get urinalysis & stool guaiac
T/F Virus - induced acute thrombocytopenia resolves without therapy and without complications in 90% of children.
true
ITP in adults may resolve spontaneously, BUT more often becomes chronic with a waxing and waning course that requires ________ in many patients.
SPLENECTOMY!!!!!!!!
ITP is the presenting problem in some patients with underling “autoimmune” diseases such as _______.
Systemic Lupus Erythematosus (SLE)
Drug induced thrombocytopenia results from either a ____ or _____ mechanism.
toxic or an antibody - mediated mechanism
What are the drugs that cause platelet DESTRUCTION causing thrombocytopenia?
- quinidine
- quinine
- sulfonamides
- heparin
- digitoxin
- phenytoin
- Methyldopa
what causes thrombocytopenia through inhibition of bone marrow production.
cancer chemotherapy
what causes platelet DYSFUNCTION through inhibition of thrmboxane production in thrombocytopenia?
aspirin
_______ occurs in hematologic malignancies as a result of bone marrow replacement with malignant cells.
decrease platelet production
T/F an autoimmune mechanism is operative in virus induced acute childhood thrombocytopenia, AIDS-associated thrombocytopenia, and chronic ITP.
true
** TTP cause is unknown
T/F Petechiae occur as a result of the throbocytopenia from platelet consumption.
true
Purpura; uncontrolled clotting results in diffuse thrombus formation. in the skin cause necrosis. uncommon life threatening diseases caused by underlying malignancy or trauma = _______
Dissementated Intravascular Coagulation (DIC)
What would you expect to see upon physical examination of Dissemenated intravascular coagulation?
purpuric , stellate ecchymosis, which appears to be necrotic in the center.
**petechiae can also be present
most lesions are flat but palpable purpura can occur in patients with edema associated with skin infarction.
is Disseminated intravascular coagulation seen in a bacterial or viral infection?
bacterial sepsis (meningococcemia)
Disseminated intravascular coagulation (DIC) may aLso be associated with malignancy particularly _____ & ______.
prostatic carcinoma & acute promyelocytic leukemia
T/F Disseminated intravascular coagulation can be precipitated by massive trauma.
true
Occasionally, Disseminated intravascular coagulation may occur as an idiopathic or post infection phenomenon ________.
purpura fulminans. *patients with this usually have had an upper respiratory tract symptoms from viral or streptococcal infection
What are the 5 causes of DIC:
- Bacterial sepsis
- Malignancy (prostatic carcinoma & acute promyelocytic leukemia)
- Amniotic fluid embolism
- Trauma
- Idiopathic (purpura fulminans)
Localized intravascular coagulation occurs in patients with protein C deficiency who are given ________. The name of the disease is _____.
warfarin (an anti-coagulation drug)
Coumadin necrosis - NO SYSTEMIC SYMPTOMS
Would a patient with DIC present with any symptoms?
- fever & shock
- infection = headache & stiff neck with meningococcal meningitis
- purpura fulminans = upper respiratory tract symptoms from viral or streptococcal infection)
- Coumadin necrosis are usually NOT infected systemically
Where would you expect to find Coumadin necrosis?
one or a few localized areas , but the skin involvement i severe and results in a full thickness slough and is localized to FATTY AREAS SUCH AS THE BREASTS AND THIGHS
Disseminated Intravascular Coagulation (DIC) is characterized by stellate purpura with dark gray central areas indicating _____ and _____.
thrombosis and infarction
How do the vasculitic lesions differ from purpura in DIC?
purpura in DIC is usually flat but may occasionally be palpable.
***IF ELEVATED lesions in DIC can be distinguished from those of vasculitis by a SKIN BIOPSY.
T/F In bacterial sepsis, vasculitis and DIC can coexist.
true
palpable purpura , lesions elevated (palpable) due to inflammation and edema because of extravasation of blood from damaged blood vessels.
Vasculitis
Cutaneous vasculitis affects only small vessels are results in purpuric papules. mediated by neutrophils and is termed _______.
Leukocytoclastic vasculitis
an idiopathic syndrome of cutaneous vasculitis associated with arthritis and abdominal pain, accompanied by gastrointestinal and renal vasculitis.
Henoch-Schonlein purpura
vasculitis confined to the skin in which an underlying cause cannot be found and has been called _______ or ______.
allergic cutaneous vasculitis or hypersenitivity vasculitis
*common but a diagnosis of exclusion
what are the 3 infectious causes of cutaneous vasculitis?
bacterial, rickettsial, viral (hepatitis C virus)
what are the two types of collagen vascular diseases causing cutaneous vasculitis?
- systemic lupus erythematosus
2. Rheumatoid arthritis
what are the two idiopathic diseases causing cutaneous vasculitis?
Henoch-Schonlein purpura
Hypersensitivity
what must be fused out and the history is the first step in doing so in diagnosing vasculitis?
systemic disease
in a patient with fever and cutaneous vasculitis, ____ must be considered as the cause of vasculitis.
sepsis
the rash in _____ starts on the wrists and ankles, abrupt onset of fever is accompanied by headache and myalgia, and is followed several days later by an erythematous rash.
Rocky Mountain spotted fever.
T/F drug induced vasculitis is common.
FALSE! very uncommon
Upon physical examination of a patient with vasculitis, what would expect to see?
purpuric papule (palpable purpura). Necrosis sometimes follows; it is heralded by the appearance of a dark gray color in the center of a lesion, followed by slough. In the absence of necrosis, lesions evolve by flattening and fading very quickly. As lesions fade, hemosiderin remains, leaving affected skin brown
In _______, lesions are distinctive in that they are putular as well as purpuric, sparse, and distributed distally on the extremities.
Gonococcemia
Patients with large vessel vasculitis, called _________, frequently experience ulcerations of the skin as a manifestation of obliterative necrosis of vessels that are larger than those involved in the vasculitis lesions.
Wegener’s Granulomatosis or polyarteritis nodosa
Henoch-Schonlein purpura is usually self limiting, but _____ persists in nearly 30% of patients.
renal impairment
Rheumatoid vasculitis is usually associated with a _____ tider of rheumatoid factor; a ______ in rheumatoid factor is usually accompanied by improvement in vasculitis.
high; reduction
vasculitis is a ________ reaction.
type III immune complex reaction
