Purpura corresponds to mini haemorrhages in the skin and mucous membranes. The blood comes out of the vessels, then stays under the skin and the mucous membrane, appearing as red dots, red spots, red lines or bruises.Cestaches do not disappear when pressed.
Purpura does not itch. It can be related to a very serious infection such as meningitis, a drop in many platelets in the blood (this is called thrombocytopenic purpura).
It can also be related to an abnormality of the blood vessels (this is called vascular purpura or rheumatoid purpura).
Purpura is sometimes an extreme emergency. Indeed, in case of fever, headache and stiffness associated with a purpura in children, we must call the SAMU.Il may indeed be purpura fulminanslinked to meningococcal meningitis . This disease requires the fastest possible care. Similarly, in an adult purpura with a spot larger than 3 mm associated with fever is an extreme emergency, because it can also be meningococcal meningitis. The antibiotic treatment is set up immediately by the UAS, even before arriving at the hospital.
In case of purpura of the skin associated with haemorrhages of the mucous membranes (mouth, eyes, genital mucosa), it is also an extreme emergency and it must also call the UAS.
There are several kinds of purpura:
Thrombocytopenic purpura :
It is due to a decrease in the number of platelets in the blood. However, platelets are small elements, smaller than red blood cells, whose role is to prevent bleeding. In case of small lesion of a vessel, platelets clump together and prevent bleeding. When they are very small, the smallest lesion can cause small bleeding, or sometimes significant bleeding.
Immune thrombocytopenic purpura (ITP), which is usually benign, must be managed quickly. The affected children generally heal completely while adults can suffer from chronic purpura. ITP is a disorder of the immune system that produces antibodies that attack its own platelets. The platelet count goes down and the risk of hemorrhage increases.
Thrombocytopenic purpura may have other causes such as certain medications, an autoimmune disease, liver disease, certain viral diseases (HIV, hepatitis B or C) or a helicobacter pylori infection (originally also ulcers in the stomach). Certain blood diseases can also lead to thrombocytopenia, not by destruction of platelets, but by a manufacturing deficit in the bone marrow.
– Vascular purpuras :
In this purpura, if the blood comes out of the vessels, it is not because of a lack of platelets, but of an attack of the small vessels, inflammatory or infectious attack, related to a virus, a bacterium, a drug or an allergic reaction of the vessels.
The affected vessels become less tight and let the blood flow, hence the stains or purpura points.
In children, the most common type of vascular purpuras is rheumatoid purpura, or Henoch-Schönlein purpura, although it may be of all ages. Small vesselsconcerned may be for example those of the skin, intestines or kidneys. This purpura can cause abdominal and joint pain. In general, rheumatoid purpura heals quickly.
The causes of purpura
The causes of appearance of purpura are very diverse. It may be due to an infection, a blood disease, the effect of a drug or an abnormal immune response.
Thrombocytopenic purpura would affect one in 10,000 people. Rheumatoid purpura would affect between 10 and 20 children out of 100,000.
The diagnosis of Purpura
It faces the presence of plates or red or purple spots not disappearing under pressure. A blood test is used to quickly determine platelets. It also helps to diagnose inflammation.
In case of purpura suggestive of meningitis, the doctor immediately starts the treatment before having the results of the analyzes. This is an emergency.
In idiopathic thrombocytopenic purpura (ITP), the platelets are low but the numbers of red and white cells are satisfactory. If the levels of red blood cells and white blood cells are not normal, the doctor asks for a myelogram , examination of the bone marrow. This examination makes it possible to detect certain diseases of the blood.
In case of signs of rheumatoid purpura (blemishes, joint pain …), some tests such as a blood test or urine tests are done, the latter to explore the functioning of the kidneys.
At the level of various organs:
Purpuras linked to immunological disorders, like the rheumatoid purpura of the child, can cause lesions elsewhere than at the level of the skin. They are related to the same factors that are to the blood coming out of the vessels inside the body. These disorders can occur in the kidneys, joints (pain, joint swelling), the digestive system (abdominal pain, vomiting) and more rarely, lungs, testicles, nervous system or bladder.
All purpuras can cause mucosal bleeding or internal bleeding related to the same phenomenon as that observed in the skin.
– The necroses:
This is the destruction of the tissue where the bleeding takes place. For example, necrosis of a skin area or internal area where haemorrhage has occurred.
What are the symptoms of purpura
- Red or purple spots, ranging from red (petechia) to larger areas. This stain does not disappear on pressure;
- bruising or hematoma;
- hemorrhages, which are signs of gravity;
- Fever, stiff neck, if purpura is linked to meningitis: it is an extreme emergency. In this case, you must call the SAMU immediately.
In case of rheumatoid purpura, other symptoms may be associated:
- joint pain
- swelling of the joints, mainly ankles and knees
- abdominal pain
- nausea, vomiting
- blood in stool
- Kidney disorders.
In case of thrombocytopenic purpura, the main symptoms may be:
- bleeding disorders
- bleeding nose, gums
- blood in urine or stool
- Abundant rules.
People at risk for Purpura
Thrombocytopenic purpura can affect all ages and all sexes. In the young adult, it concerns more women than men. Conversely, around age 50, men are more affected than women.
Rheumatoid purpura is more concerned with children and young adults, with a majority of cases around 5 years old. Boys would be more affected than girls.
Medical treatments of purpura
For purpura fulminans , we speak of unpurpura of extreme gravity, with 20 to 25% mortality with, among the survivors, 5 to 20% of serious complications. This purpura is most often linked to meningococcus, but also to other infectious elements (chickenpox, streptococcus, staphylococcus …). The treatment must be made in emergency and hospitalization necessary. Of antibiotics will be given immediately upon the arrival of the ambulance or doctor before even expect results. Those most at risk are children under 4 and young people between 15 and 24 years old.
In case of immunological thrombocytopenic purpura (ITP), the first goal of treatment is to raise the platelet count if it is below 30 000 / mm. (Normal rate between 150,000 and 400,000 / mm ). If it is 30,000 / mm or more, even if the number of platelets is abnormally low, this usually does not cause hemorrhages. On the other hand, if the platelet count is less than 30 000 / mm, it is an emergency since the person risks bleeding. Treatment with corticosteroids ( cortisonederivatives )may be prescribed but this treatment must be brief, because it has significant side effects. Other treatments such as immunoglobulin injections can also be implemented.
In case of chronic immunologic thrombocytopenic purpura, the most effective treatment is to remove the spleen. Indeed, this organ manufactures antibodies destroying platelets and it also contains white blood cells, macrophages destroying platelets. Then, the removal of the spleen (splenectomy), can cure 70% of chronic thrombocytopenic purpura immunological. You can live without a spleen, even if it exposes you to a higher risk of infection.
If withdrawing the spleen is not enough or insufficiently effective, other treatments exist, such as drugs reducing the immune response, antibodies derived from biotherapies or drugs such as Danazol or Dapsone.
In case of rheumatoid purpura, it is possible, again, no treatment is proposed, purpura disappearing without sequelae over time. The rest is advised, sometimes accompanied antispasmodic to fight against abdominal pain.