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Definition
Purpura: Refer to escape (extravasations) of blood into the skin
and mucous membrane. It is associated with changes in the blood e.g. diminution
in the number of platelets (thrombocytopenia)
TYPE OF PURPURA
A.
VASCULAR
PURPURA
- Petechiae:-
Small red or purple patches due to haemorrhage into skin
- Ecchymoses:-
Escape of blood into tissue producing a large bruise
- Patechiae and
ecchymosses:- May occur as a result of blood vessel rupture
- Symptomatic or
secondary purpura:- These are due to damage of vessel wall by
infections e.g meningococcaemias bacterial endocarditis etc
- Severe
arterial hypertension:- May cause bruising easily valsalva manoeuvre
may cause petechiae
- Anophyloctoid
purpura:- It is an allergic purpura
It is associated with the following:-
a)
Arthritis, abdominal pain, haemoturia, gastrointestinal
haemorrhages and fever
b)
Athacks last for several weeks and recur for years
- Familial
haemorrhageic telangiectasis:- It is inherited. There is bleeding and
bruising
a)
Causes not known
b)
Does not respond to any treatment
- Toxic
purpura:- Caused by certain drugs and poisons
- Vitamin C
deficiency: - Avascular purpura
- Semile
purpura:- Occur to old people
- Collagen and
vascular diseases
- Steroid
purpura
B.
THROMBOCYTOPENIA
This is reduction of the circulating
platelets, may lead to bleeding
Altered physiology and causes
- Decreased platelet production in e.g diseases of the
bone marrow, leukemia, myelosuppressive therapy tummours,
myelofibrosis radiotherapy drugs,
aplastic anaemia etc.
- Increased platelet destruction (infections, immune
thrombocytopenic purpura, disseminated intravascular coagulation, drug
induced etc.)
- Abnormal distribution or sequestration hypersplemism
- Loss of platelets from the body (extracorporeal
circulation dilution due to blood loss and multiple blood transfusion)
C.
IDIOPATHIC
AUTOIMMUNE THROMBOCYTOPENIC PURPURA
- This is a group of bleeding disorders due to immune
destruction of platelets
- anti platelets antibodies are produced for unknown
reasons and the life span of the platelets is markedly shortened
- Antibody coated platelets are removed from the
circulation by reticuloendothelial cells of the spleen and liver
Causes of purpura
- Platelet defect
- Bone marrow suppression
- Drugs eg
sulphonamid, quinine antibiotics etc.
- Vitamin c deficiency
- Uraemia
- allergic reaction
- Infection
- Capillary abnormality
- Old age
ASSESSMENT
CLINICAL FEATURES
- May be acute or chronic
- Bleeding when platelet below 2- x 109/litre
- Skin lesions – Small haemorrhage
- Purpuric lesions in vital organs e.g. brain
- Bleeding may occur from nose, mouth,genital and
urinary tract etc
LABORATORY FEATURES
- Platelets may be reduced or absent. There is change
in size and shape
- Increased level of immunoglobulins or complement on
the platelet surface
- Bone marrow examinations shows increase of mega
karyocytes
TREATMENT AND NURSING INTERVENTION
OBJECTIVES
a)
Search the possible cause of bleeding
b)
Treat patient during spontaneous bleeding
- Corticosteroids (prednisone) reduced bleeding
- Prepare patient for splenectomy splenish a major site
for platelet breakdown
- Immunosuppressive therapy for those not responding to
corticosteroids and splenectomy. The drugs are a zathioprine,
cyclophosphamide, vincristine etc
- Support patient receiving transfusions
a)
Fresh blood collected within 24 hours as a source of
platelets and blood cloting, restore blood correct anaemia
b)
Transfuse with platelets usually used in bone marrow
suppression caused by drugs thrombocytopenia or that cause by idiopathia
purpura
- Utilize other measures to assist a patient with
haemorrhagic tendencies
PATIENT EDUCATION
Instruct the patient as flows:
- Protect himself from infectious complications if on
long term steroids therapy
- Avoid aspirin
- Avoid potential sources or accidents and injuries
COMPLICATIONS
- Anaemia
- Bleeding
- Damage of vital organs by purpura lesion e.g the
brain
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