Purpura and Petechiae

CLINICAL DIAGNOSTIC MANUAL

Bleeding disorders are a group of conditions that affect the body’s ability to control bleeding, either due to problems with blood components (platelets and clotting factors) or with the blood vessels themselves.

These disorders can manifest through symptoms ranging in severity from mild bruising to severe, life-threatening haemorrhages.

A thorough evaluation is essential to determine the underlying cause and guide appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Idiopathic thrombocytopenic purpura	Appearance of petechiae and purpura on the skin and mucous membranes, absence of other abnormalities.	Low platelet count with no apparent cause.	Exclusion of other causes, response to corticosteroid therapy.
Thrombotic thrombocytopenic purpura	Purpura, fever, altered mental state, renal failure, haemolytic anaemia.	Neurological symptoms, anaemia, and thrombocytopenia.	Reduced ADAMTS13 test, presence of Schistocytes on blood smear.
Vitamin K deficiencies	Easy and prolonged bleeding, presence of bruising, bleeding in mucous membranes.	Poor dietary history in vitamin K, use of anticoagulants.	Low levels of vitamin K and improvement with its administration.
Von Willebrand disease	Easy bleeding, frequent nosebleeds, heavy menstruation, prolonged bleeding after surgeries.	Family history of bleeding, personal symptoms.	Low levels of von Willebrand factor and factor VIII coagulant.
Leukaemias and other myeloproliferative disorders	Fatigue, pallor, recurrent fever, frequent infections, haemorrhages, and petechiae.	Abnormal findings on complete blood count.	Confirmation through bone marrow biopsy and cytogenetic studies.
Severe infections	High fever, signs of sepsis, rapid and progressive petechiae or purpura.	Presence of signs of infection and coagulopathy.	Positive cultures and specific tests according to the suspected pathogen.
Collagen diseases (e.g., lupus)	Rash, arthralgias, fever, systemic symptoms, presence of petechiae and purpura.	Multisystem symptoms and serological findings.	Positive antinuclear antibodies and other diagnostic criteria for lupus.
Drug reactions	Recent exposure to new medications, development of petechiae or purpura, often with itching or rash.	Medication initiation history and onset of symptoms.	Resolution of symptoms after discontinuation of the drug.
Vasculitis	Palpable purpura, fever, weight loss, general malaise, muscle and joint pain.	Clinical findings of blood vessel inflammation.	Skin or affected organ biopsy showing vasculitis.
Septicaemia	High fever, tachycardia, hypotension, rapid and widespread petechiae, multi-organ dysfunction.	Presence of severe infection symptoms and shock.	Positive blood cultures and clinical signs of septicaemia.