The following symptoms and complaints may indicate purpura (skin and mucous membrane bleeding):
Leading Symptoms
- Purpura – reddish-dark red lesions caused by small-spotted capillary hemorrhage in the skin (gr. derma; also cutis from Latin cutis), subcutis, or mucous membranes (skin and mucosal hemorrhage); the individual hemorrhage may present as follows:
- Petechie (lat. petechia, pl. petechiae) – smallest punctate skin/mucous membrane hemorrhage.
- Ecchymosis (from Old Greek ἐκχύμωσις (ἐκ – out, χέω – I pour); Lat. ecchymosis) – areal skin/mucous membrane hemorrhages [larger than petechiae but smaller than sugillations].
- Sugillation (lat. sugillare: to strike brown and blue) – extensive skin/mucous membrane hemorrhages (up to 30 mm leakage of blood from capillaries).
- Vibex (vibices. Etymol.: lat. striae(s)) – striate skin/mucous membrane hemorrhages (rare).
- Skin lesions do not fade on pressure.
The patient thinks he bruises quickly.
Caveat. (Note!)
- Genetic (hereditary) blood coagulation disorders can also occur spontaneously; thus, a negative family history is not sufficient as a criterion for exclusion
- At the slightest suspicion of meningococcal sepsis, penicillin must be administered immediately and the child must be taken to the hospital.
- Never administer intramuscular injections for suspected coagulopathy!
Warning signs (red flags)
- Anamnestic information:
- Age + localization (chronically sunlight-exposed skin areas, especially dorsum of hands and forearm extensor sides) → think: senile purpura.
- Children → think of: Child abuse (inspection of the anogenital region).
- Purpura + pronounced pallor → think of: Suspicion of bone marrow disease; immediate diagnosis is required here!
- Multiple hematomas → think of: Blood clotting disorder
