Page 346 - Essential Haematology

332 / Chapter 25 Bleeding disorders

(a)

(b)

Figure 25.1 (a) Hereditary haemorrhagic telangiectasia: the
characteristic small vascular lesions are obvious on the lips and
tongue. (b) Senile purpura. (c) Characteristic perifollicular
(c) petechiae in vitamin C defi ciency (scurvy).

2 Senile purpura caused by atrophy of the support- joint swelling, haematuria and abdominal

ing tissues of cutaneous blood vessels is seen pain may also occur. It is usually a self - limiting
mainly on dorsal aspects of the forearms and condition but occasional patients develop renal
hands (Fig. 25.1 b). failure.

3 Purpura associated with infections, mainly of 5 Scurvy. In vitamin C deficiency, defective colla-

bacterial, viral or rickettsial origins may cause gen may cause perifollicular petechiae, bruising
purpura from vascular damage by the organism and mucosal haemorrhage (Fig. 25.1 c).
with DIC or as a result of immune complex 6 Steroid purpura. The purpura, which is associ-

’
formation (e.g. measles, dengue fever or menin- ated with long - term steroid therapy or Cushing s
gococcal septicaemia). syndrome, is caused by defective vascular sup-
4 The Henoch – Sch ö nlein syndrome is usually portive tissue.

seen in children and often follows an acute
upper respiratory tract infection. It is an Tranexamic acid and aminocaproic acid are
immunoglobulin A (IgA) - mediated vasculitis. useful antifi brinolytic drugs that may reduce bleed-

The characteristic purpuric rash accompanied ing resulting from vascular disorders or thrombocy-
by localized oedema and itching is usually most topenia but are relatively contraindicated in the
prominent on the buttocks and extensor surfaces presence of haematuria because they might lead to
of the lower legs and elbows (Fig. 25.2 ). Painful clots obstructing the renal tract.