What are petechiae?
Petechiae are small punctiform bleedings that can occur in all organs. Typically, petechiae become noticeable when they are in the skin. Petechiae cannot be pushed away, unlike other punctiform changes in the skin.
If you press the petechiae with a glass spatula, they do not disappear, as they are bleedings and not malformations of blood vessels. Petechiae are mainly caused by blood clotting disorders. Tiny injuries in small blood vessels can no longer be sufficiently closed by thrombocytes (blood platelets), which are very important for stopping bleeding.
This is either due to an insufficient number of thrombocytes (thrombocytopenia) or the thrombocytes are not fully functional (thrombocytopathy). Another cause of the small bleedings is excessive injury to the blood vessels. One example is an inflammation of the blood vessels, called vasculitis.
The most common causes:
Thrombocytopenia (lack of platelets) Thrombocytopathy (dysfunction of the platelets) Vasculitis of the small vessels Autoimmune diseases Vitamin deficiency Infectious diseases Exhausting sports Stress Leukemia Overdoses of medication Side effects of medication
- Thrombocytopenia (lack of platelets)
- Thrombocytopathy (functional disorder of the thrombocytes)
- Vasculitis of small vessels
- Autoimmune diseases
- Vitamin deficiency
- Infectious Diseases
- Exhausting sport
- Stress
- Leukemia
- Drug overdoses
- Drug side effects
Thrombocytopenia means that there is a lack of platelets. Platelets are also called blood platelets. The main function of thrombocytes is the so-called primary blood coagulation, i.e. the first and rapid closure of larger and smaller wounds.
Thrombocytopenia can be caused on the one hand by The reduced production is due to a disorder of the bone marrow in which the blood cells are produced. The production there can be disturbed by various processes: Reasons for an increased turnover of platelets can be autoimmune diseases, where antibodies against platelets are formed. These antibodies bind to the thrombocytes and ensure that they are recognized and destroyed by the immune system.
- A reduced production of thrombocytes or
- An increased degradation can be caused.
- These include malignant processes such as leukemia or the absorption of substances that damage the bone marrow.
- A vitamin B12 or folic acid deficiency also leads to fewer thrombocytes being produced.
There is a variety of different vasculitides. The common feature of these diseases is that they are autoimmune diseases. This means that the body actually recognizes the body’s own cell components as foreign and triggers an immune reaction against them.
The consequence of this reaction is an inflammation. Vasculitides are divided into vasculitis of the large, medium and small vessels. Vasculitides of the small vessels in particular can trigger petechiae, since the smallest vessels, the capillaries, are damaged, causing blood to leak into the surrounding tissue.
However, vasculitides are often not only accompanied by bleeding into the skin, but can also be noticed in any organ of the body that is supplied with blood. Vitamins are essential substances for the body and must be taken in with food. The body cannot produce vitamins itself.
Therefore, malnutrition or a disorder in the absorption of vitamins can lead to a variety of diseases. A deficiency that rarely occurs nowadays is vitamin C deficiency, which causes not only tooth and hair loss but also petechiae. The combination of the different symptoms is called scurvy and was formerly very common among sailors.
The reason for the pronounced symptoms is a disturbance in collagen synthesis, as vitamin C is needed for this. Collagen is an important component of the connective tissue. The result is a generalized weakness of the connective tissue.
Other vitamins that can trigger petechiae in the event of a deficiency are vitamin B12 and folic acid. These are very important for DNA production. If this is disturbed, cells can no longer divide so well.
As a result, blood production is reduced.This also affects the thrombocytes, which can no longer fulfil their haemostatic function. Under certain circumstances this can also lead to petechiae. Petechiae are usually caused by damage to the small blood vessels or disturbed blood clotting.
If the cause of petechiae cannot be found, other possible causes are discussed. It is possible that an increased stress level is a co-trigger for petechiae. Stress increases the body’s basal metabolic rate, but petechiae are not a typical consequence of stress.
If you discover petechiae on your body and suffer from a persistent stress, it may be caused by a disease that causes these symptoms. A detailed clarification and an overview of all symptoms is important to identify an underlying disease. Regular exercise is primarily beneficial to the health of the cardiovascular system.
Exercise should be chosen in such a way that it is strenuous but does not cause pain or overexertion. Petechiae do not occur during strenuous sporting activity in a healthy person. If you discover petechiae in you after you have done very strenuous sports, a doctor should be consulted.
In this case, petechiae are most likely to be the cause of a vitamin deficiency or blood clotting disorder. Petechiae can occur when certain drugs are administered in too high a dose. Platelet aggregation inhibitors are particularly predestined for this.
The best-known substance in this group is acetylsalicylic acid, or ASA for short – the active ingredient of aspirin. This causes a certain enzyme in the thrombocytes to be inhibited. As a result, thrombocytes are less able to adhere to each other and the formation of blood clots is prevented.
If the dose is chosen too high, petechiae will occur, as minimal injuries to the vessel wall can no longer be sufficiently sealed. Other active ingredients in this class are clopidogrel or ticagrelor. If drug side effects are a possible cause of petechiae, the so-called HIT (heparin-induced thrombocytopenia) is the most common.
Heparin is the drug of choice if one wants to prevent thromboses from developing. It is used for longer immobilization periods. In addition, it is used in myocardial infarction and other heart diseases to prevent further vascular occlusion.
The most feared side effect of heparin is heparin-induced thrombocytopenia. Now it is reasonable to assume that this side effect leads to increased bleeding due to a reduction in the number of thrombocytes. However, the opposite is the case.
Thromboembolic events, i.e. blood clots that can become life-threatening, occur more frequently. The cause of this side effect is an autoimmune-mediated reaction to a complex of heparin and a protein produced by thrombocytes. The resulting immune complexes of heparin, protein and antibody can bind to platelets and thus cause the platelets to cluster together and thus cause blood clotting.
Coughing and vomiting both primarily cause increased intra-abdominal pressure, i.e. an increase in the pressure prevailing in the abdominal cavity. Coughing and vomiting can certainly lead to bleeding, but it is more likely to occur in the affected organs. However, if petechiae occur in coughing or vomiting, there is probably another cause.
- When coughing, the mucous membrane of the respiratory tract can become irritated and bleed.
- If the vomiting is very strong, slight bleeding of the mucous membrane of the stomach and the esophagus may occur.
- Heavy bleeding occurs particularly in the context of alcohol dependency.
Purpura Schönlein-Henoch is a vasculitis of the small arteries, which occurs particularly frequently in children. The affected children often suffered an infection of the upper respiratory tract in their recent history. The consequences of the vasculitis are mostly bleedings into the skin in the form of petechiae.
The cause is probably antibodies that are formed during the infection. The prognosis of the disease is very good, the affected persons usually recover quickly and a healing without consequences can be expected. Leukemia (white blood cancer) is a malignant disease in which there is a strong increase in white blood cells (leukocytes).
The formation of the blood cells takes place in the bone marrow.Due to the proliferation of cancer cells in the bone marrow, normal blood cells are displaced. The result is anemia, i.e. a too low number of red blood cells (erythrocytes), and thrombocytopenia. The lack of thrombocytes then leads to an increased tendency to bleed and petechiae.
In addition to these bleedings, leukaemia leads to a rapid fatigue. Blood poisoning is the spreading of pathogens through the blood. The technical term for blood poisoning is sepsis.
Sepsis is a very serious clinical picture and can be accompanied by petechiae. The petechiae in sepsis are caused by toxins of the bacteria that have entered the blood. These so-called endotoxins lead to an excessive activation of the coagulation system.
This activation leads to thromboses and embolisms on the one hand, and to bleeding on the other. The bleeding can occur as petechiae, but large-area bleeding can also occur. This complication of sepsis is called Waterhouse-Friderichsen syndrome.
Meningitis (inflammation of the meninges) is an inflammation of the membranes surrounding the brain (meninges). The disease can be caused by viruses, bacteria or, more rarely, by other microorganisms. Viral diseases often have a milder course, while bacterial meningitis is severe and can quickly lead to death if left untreated.
Petechiae occur particularly with one particular pathogen, the meningococcus. These trigger meningococcal meningitis, which can trigger Waterhouse Friderichsen syndrome as a severe complication. In this complication, petechiae occur as a result of activation of blood coagulation, and multiple thrombi and embolisms can also lead to multiple organ failure.
Changes in pressure due to external pressure can lead to bleeding. In principle, however, the resulting bleedings are rather extensive and a typical bruise is formed. Suction at a point on the skin that is very thin, such as the neck, causes blood vessels supplying the skin to tear due to a strong negative pressure.
However, these bleedings are not petechiae either, but haematomas, i.e. typical bruises. A lack of blood circulation causes an undersupply of the tissue and results in damage to the tissue that is poorly supplied with blood. Depending on the severity of the blood circulation deficiency, only a slight restriction of function may occur.
However, there can also be such a severe blood circulation deficiency that the tissue dies. In the case of a blood circulation deficiency, the affected tissue appears brighter because less blood is available. Petechial haemorrhages are not likely to be observed in the case of a blood circulation deficiency.
