Petechiae, Purpura, and Vasculitis Flashcards
What is purpura?
• is it blanchable?
• what causes it?
Purpura is pink to purple macules/patches or papules caused by extravasated RBCs (b/c these RBCs are extravasated the lesions are NON-blanchable)
***essentially just blood under the skin***
What are the main causes of purpura?
• 3 main ones
• Coagulation and Clotting dysfunction
• Leaky or abnormal vessels
• Trauma
What are the 2 categories that we can put purpura into?
• what is suggested about the underlying lesion based on the etiology?
2 categories: Palapable and Non-palpable
Palpable:
• Suggests inflammation => VASCULTIS
- *Non-palaplable:**
- *• Suggests non-inflammatory cause**
What is shown here?
• based on the location of these lesions would you expect that this person was ambulating?
• Do you think this patient is in pain from these lesions?
Petechiae (small purpura) are shown here. They are less than 3mm and are on DEPENDENT AREAS of the body (aka they’ll go wherever blood is pooling). These are generally painless.
What are two general causes for the condition shown?
Petechiae: either platelet (asprin/thombocytopenia) or capillary related (loss of structural integrity or leak)
The condition shown here is a complication of what disease?
• unique features?
Petechiae as the result of Scurvy is seen here, this is a problem of weak capillaries. PERIFOLLICULAR distribution is characteristic.
(remember Vit C is needed for Lysl and Prolyl hydroxylase that is needed to make collagen specifically type III for vessels)
Are ecchymosis purpura?
• palpable or na?
Ecchymosis are non-papable (press with a glass slide and it won’t blanch) purpura that are larger (greater than 5mm) and may or may not be tender. aka a Bruise
What is suggested by an Ecchymosis that is not traumatic in nature?
Ecchymosis are more likely to be caused by an abnormality in coagulation - HYPER or HYPO coagulable (remember petechiae are more likely a problem with platelet function or capillaries themselves)
What is this large non-blanchable lesion?
Ecchymosis
The causes of non-papable purpura are multiple.
• what are 5 defects that can cause their formation?
PETECHIAE
Thrombocytopenia + infection/inflammation/trauma
Abnormal platelet function + infection/inflammation/trauma
Poor dermal support + Trauma
Infection
Ecchymosis
- *Anticoagulation + trauma => Ecchymosis**
- *Poor dermal support + Trauma**
What is shown here?
• Cause?
Solar Purpura that is from a lack of dermal support to capillaries as a result of UV damage and minor trauma
What is shown here?
• underlying cause?
• Linear purpura - caused by a blood pressure cuff that has caused minor trauma in a thrombocytopenic patient
This person was hospitalized for 2 weeks and when the pneumatic compression device was taken off of their legs this is what was shown.
• what has caused this?
Trauma (leg compressors) + Steriod induced atrophy + sun (actinic) damage = Purpura
Differentiate the principle causes of the 2 different types of non-palpable purpura.
• principle cause of each?
What is seen here?
Hypergammaglobulinemic purpura from Waldenstrom
What is the Hallmark of Leukocytoclastic Vasculitis?
Palpable Purpura (raised lesions, close your eyes and feel them)
What do you expect Henoch-Schonlein purpura to look like?
• Palpable or na?
• (bonus) who do you expect to see with this and what’s the Cause?
Henoch-Schonlein purpura is a vasculitis so these will be papable.
Bonus: this disease is causes by a vasculitis caused by IgA immune complex deposition. Typically presents in a kid that is post upper respiratory tract infection that has paplable purpura on his butt and legs with GI bleeding and IgA nephropathy (berger disease). Disease is typically self-limited.
What is shown here?
• this is a Vasculitis You can see blood extravasated from the vessels in the dermis alson with blue inflammatory cells surrounding the vessels.
What is shown here?
Pink donut of Fibrin around a vessel with neurtrophilic inflammation
What is this?
Small vessel vasculitis - notice that its raised
What is this?
Small Vessel Vasculitis
What feature is shown of this lupus patient?
Small Vessel Vascultitis of Lupus
What is shown here?
Palpable Purpura associated with a paraneoplastic vasculitis
This patient came in with a severe headache and these lesions. What could this be?
These look raised so it is a vasculitis. Given the history of headache you should worry about the possibility of a small vasculitis due to meningicoccal disease.
Where are leukocytoclastic Vasculitities typically located?
Dependent areas.
• this person was probably up and walking around
****KEY TO RECOGNIZE PURPURA AS A HALLMARK FINDING OF LEUKOCYTIC VASCULITITIS****
This patient was just given a new drug. What do you suspect is happening?
• Vasculitis due to DRUGS in this hopitalized patient. Key that this is found in dependent areas (this guy has been laying on this back)
Lesions differ on the basis of the vessel involved. What lesions present with small vessel pathology?
Lesions differ on the basis of the vessel involved. What lesions present with medium vessel pathology?
Lesions differ on the basis of the vessel involved. What lesions present with large vessel pathology?
What disease is depicted here?
Henoch-Schonlein purpura
Shown here is a symptom of what type of vasculitis?
Livedo Riticularis - associated with Polyarteritis Nodosa
What key features of polyarteritis nodosa are seen here?
• Medium vessels are affected so the small vessels in the periphery are pretty much left alone, but the deeper medium sized vessels show intense inflammation with fibrosis
What is shown here?
• cause?
Retiform (web-like) purpura
• this is a type of ecchymosis with a net-like pattern that results from vascular ischemia typically due to an underlying clotting disorder
SPECIFICALLY b/c its widespread this is purpura fulminans
Shown here is Pupura Fulminans in a very septic patient, what is the cause of the widespread ecchymosis (these are bruises)
• DIC has causes tons of coagulation and loss of platelets resulting in widespread purpura
What do you expect a biopsy of this cocaine users ecchymosis to show?
Clogged Blood Vessels due to widespread coagulation everything else is pretty normal (see below)
