Purpura Flashcards
Features of HSP (2)
=IgA mediated vasculitis, essentially IgA nephropathy w. other features
most patients will have preceeding URTI
Presentation of HSP (7)
Classic triad:
- Hurting joints
- Stomach pain
- Purpura
other features:
- renal involvement
- pyrexia
- scrotal oedema
- intussusception
Ix for HSP (5)
raised ESR
raised IgA
Proteinuria
ASOT
Check U+Es and BP regularly
Mx of HSP (2)
steroids may help abdo pain
most should resolve after 2mo
F/U:
- wkly for first month-checking urine
- 2wkly for second mo.
- monthly thereafter until urine normal
Complications of HSP (3)
massive GI bleed due to infarction/perforation
AKI
haemoptysis
Features of ITP (3)
anti-platelet antibodies
platelets destroyed in spleen
most acquired bleeding disorder in children
Acute presentation of ITP (4)
bruising w. minimal trauma
petechiae
intracranial bleeding
often Hx of URTI or gastroenteritis
(Mild: bruising/ petechiae/ minor epistaxis
Moderate: large bruises/ mucosal lesions and intermittent bleeding gums/ GI tract, epistaxis >20 mins/ menorrhagia/ malaena/haematemesis
Severe: severe epistaxis/ malaena/ menorrhagia/ intracranial haemorrhage.)
Ix for ITP
FBC shows isolated thrombocytopenia
do CT head if headache/CNS signs present as <1% develop cerebral haemorrhage which is leading cause of death in ITP
Mx of ITP (5)
most resolve spontaneously but some become chronic
if no active bleeding:
-admit for fluids and monitoring
if active bleeding:
- platelet transufion
- steroids/IVIg don’t halt disease but can raise platelet count
- splenectomy can be indicated
- rituximab and anti-D may prevent need for splenectomy
Features of TTP (2)
hereditary or acquired (Abs) defect in ADAMTS13 which cleaves vWF
can be precipitated by oestrogens or pregnancy
Features of neonatal thrombocytopenia (2)
falling platelets in first 72hrs due to incompatible platelet Ags
can occur in utero>CNS problems
Mx of neonatal thrombocytopenia (2)
compatible platelets/irradiated maternal platelets
IVIg+steroids
(can recur in later pregnancies)
