DERMATOLOGY
PETECHIAE/PURPURA
Prompt
Response
PromptRash descriptors
ResponsePatechiae and purpura
Location
Additional features ? bruising
Commont on child in general - looks sick/unwell/pale
Location
Additional features ? bruising
Commont on child in general - looks sick/unwell/pale
PromptDifferentials for Petechiaie/purpura
ResponseAutoimmune
Other Framework:
Increased vascular permeability - Eg: HSP
Decreased plt production - Eg Malignancy
Increased plt consumption - Eg Sepsis + DIC
- ITP
- HSP
- Autoimmune haemolytic anaemia
- SLE
- Aplastic cirsis/bone marrow failure
- VonWillebrand disease
- Hereditary platelet syndrome
- Evans syndrome (+anaemia + thrombocytopaenia)
- Leukaemia, ALL, CML, CLL
- Lymphoma
- Myelodysplasia
- Viral induced thrombocytopaenia - EBV/CMV/HIV/Varicella/Rubellar related
- Hep A/B/C
- Meningiococcaemia
- Immune deficient syndrome (CVID
- HIV
- Recent immunisations
- Heparin
- Antibiotics - cefalosporins
- Analgesics - ibuprofen/aspirin
Other Framework:
Increased vascular permeability - Eg: HSP
Decreased plt production - Eg Malignancy
Increased plt consumption - Eg Sepsis + DIC
PromptConcerning clinical features in purpura/patechiae
ResponseImpaired LOC/drowsiness
Abnormal vitals, increased HR/RR, desaturation
Poor perfusion
Purpura (over petechiae)
Rapid progression/spread of petechiae/purpura
Abnormal vitals, increased HR/RR, desaturation
Poor perfusion
Purpura (over petechiae)
Rapid progression/spread of petechiae/purpura
PromptImmune thrombocytopaenic purpura (ITP)
ResponseITP usually = Well child with rash
ITP is an autoimmune bleeding disorder characterised by all 3 of
i) Isolated thrombocytopaenia (plt <100, but often <20)
ii) Otherwise normal FBC and film
iii) well child with no concerning features on history or examination
Diagnosis of exclusion, no specific confirmatory labs. Often resolves within 3 months, and 75% of childrens within 6 months. Chronic is >12 months.
Often require no treatment
-RCH
ITP is an autoimmune bleeding disorder characterised by all 3 of
i) Isolated thrombocytopaenia (plt <100, but often <20)
ii) Otherwise normal FBC and film
iii) well child with no concerning features on history or examination
Diagnosis of exclusion, no specific confirmatory labs. Often resolves within 3 months, and 75% of childrens within 6 months. Chronic is >12 months.
Often require no treatment
-RCH
PromptIndications for treatment in ITP
ResponsePlt <10
ICH/significant bleeding
ICH/significant bleeding
PromptTreatment for ITP (If required)
ResponseFirst line: Prednisone 2mg/kg
Second line: IVIG 1g/kg
Severe/life threatening: Above PLUS:
Plt 20 mL/kg +/- repeat
Pulse methylpred 15-30 mg/kg x 3 days
TXA 15 mg/kg
Avoid antiplatelet/anticoagulation
RCH
Second line: IVIG 1g/kg
Severe/life threatening: Above PLUS:
Plt 20 mL/kg +/- repeat
Pulse methylpred 15-30 mg/kg x 3 days
TXA 15 mg/kg
Avoid antiplatelet/anticoagulation
RCH
PromptSee also Paeds - lots of rash stuff there
Response