Skip to Main Content

  icon Rare
  icon Not so common
  icon Common
  icon Low morbidity
  icon Considerable morbidity
  icon Serious

++

ICD-9 : 287.31 • ICD-10 : D69.3   Image not available. Image not available. Image not available. Image not available.

++

  • Thrombocytopenic purpura (TP) is characterized by cutaneous hemorrhages occurring in association with a reduced platelet count.
  • Hemorrhages are usually small (petechiae) but at times larger (ecchymoses).
  • Occur at sites of minor trauma/pressure (platelet count < 40,000/μL) or spontaneously (platelet count < 10,000/μL).

++

Epidemiology

++

Age of Onset

++

Acute idiopathic thrombocytopenic purpura (ITP) mostly in children; drug-induced and autoimmune TP in adults.

++

Sex

++

Both sexes; HIV-associated TP—homosexual men > heterosexual females.

++

Etiology and Pathogenesis

++

Due to either decreased platelet production, splenic sequestration, or increased platelet destruction.

++

  1. Decreased platelet production. Direct injury to bone marrow, drugs (cytosine arabinoside, daunorubicin, cyclophosphamide, busulfan, methotrexate, 6-mercaptopurine, vinca alkaloids, thiazide diuretics, ethanol, estrogens), replacement of bone marrow, aplastic anemia, vitamin deficiencies, Wiskott-Aldrich syndrome.

  2. Splenic sequestration. Splenomegaly, hypothermia.

  3. Increased platelet destruction. Immunologic: autoimmune TP, drug hypersensitivity (sulfonamides, quinine, quinidine, carbamazepine, digitoxin, methyldopa), after transfusion. Nonimmunologic: infection, prosthetic heart valves, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura.

++

Platelet plugs by themselves effectively stop bleeding from capillaries and small blood vessels but are incapable of stopping hemorrhage from larger vessels. Platelet defects therefore produce problems with small-vessel hemostasis, small hemorrhages in the skin or in the CNS.

++

Clinical Manifestation

++

Usually sudden appearance of asymptomatic hemorrhagic skin and/or mucosal lesions.

++

Skin Lesions

++

Petechiae—small (pinpoint to pinhead), red, nonblanching macules that are not palpable and turn brown as they get older (Fig. 19-1); later acquiring a yellowish-green tinge. Ecchymoses—black-and-blue spots; larger area of hemorrhage. Vibices—linear hemorrhages (Fig. 19-1), due to trauma or pressure. Most common on legs and upper trunk, but may be anywhere.

++
Figure 19-1
Graphic Jump Location

Thrombocytopenic purpura Multiple petechiae on the upper arm of an HIV-infected 25-year-old male were the presenting manifestation of his disease. The linear arrangement of petechiae at the site of minor trauma are called vibices.

++
Mucous Membranes
++

Petechiae—most often on palate (Fig. 19-2), gingival bleeding.

++
Figure 19-2
Graphic Jump Location

Thrombocytopenic purpura Can first manifest on the oral mucosa or conjunctiva. Here multiple petechial hemorrhages are seen on the palate.

++
General Examination
++

Possible CNS hemorrhage, anemia.

++

Laboratory Examinations

++

Hematology

++

Thrombocytopenia.

++

Bone Marrow Aspiration

++

Defines state of platelet production.

++

Serology

++

Rule out HIV disease.

++

Lesional Skin Biopsy

++

May be contraindicated due to postoperative hemorrhage; however, usually can be ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.