purpura /pur·pu·ra/ (pur´pu-rah)
thrombocytopenic purpura
purpura (pur´pyoor
),
1. a small hemorrhage in the skin, mucous membrane, or serosal surface.
2. a group of disorders characterized by the presence of purpuric lesions, ecchymoses, and a tendency to bruise easily.purpu´ric
allergic purpura , anaphylactoid purpura Henoch-Schönlein p.
purpura annula´ris telangiecto´des a rare form in which punctate erythematous lesions coalesce to form an annular or serpiginous pattern.
fibrinolytic purpura purpura associated with increased fibrinolytic activity of the blood.
purpura ful´minans nonthrombocytopenic purpura seen mainly in children, usually after an infectious disease, marked by fever, shock, anemia, and sudden, rapidly spreading symmetrical skin hemorrhages of the lower limbs, often associated with extensive intravascular thromboses and gangrene.
purpura hemorrha´gica idiopathic thrombocytopenic p.
Henoch's purpura Henoch-Schönlein purpura in which abdominal symptoms predominate.
Henoch-Schönlein purpura nonthrombocytopenic purpura of unknown cause, usually in children; associated with symptoms such as urticaria, erythema, arthropathy and arthritis, gastrointestinal disorder, and renal involvement.
idiopathic thrombocytopenic purpura thrombocytopenic purpura not directly associated with a systemic disease, although often following a systemic infection; believed to be due to an IgG immunoglobulin that acts as an antibody against platelets.
malignant purpura meningococcal meningitis.
nonthrombocytopenic purpura purpura without any decrease in the platelet count of the blood.
Schönlein purpura Henoch-Schönlein purpura with articular symptoms and without gastrointestinal symptoms.
Schönlein-Henoch purpura Henoch-Schönlein p.
purpura seni´lis dark purplish red ecchymoses occurring on the forearms and backs of the hands in the elderly.
thrombocytopenic purpura any form in which the platelet count is decreased, occurring as a primary disease (idiopathic thrombocytopenic p.) or as a consequence of a primary hematologic disorder (secondary thrombocytopenic p.) .
thrombotic thrombocytopenic purpura a form of thrombotic microangiopathy marked by thrombocytopenia, hemolytic anemia, neurological manifestations, azotemia, fever, and thromboses in terminal arterioles and capillaries.
| thrombocytopenic purpura |
thrombocytopenic purpura
[-sī′təpē′nik]
Etymology: Gk, thrombos + kytos, cell, penia, poverty; L, purpura, purple
a bleeding disorder characterized by a marked decrease in the number of platelets, resulting in multiple bruises, petechiae, and hemorrhage into the tissues. Causes include infection and drug sensitivity and toxicity. A diagnosis is reached only by the exclusion of other causes. Considered to be a manifestation of an autoimmune response, two distinct entities, acute and chronic thrombocytopenia, can be differentiated on clinical manifestations alone. The acute form usually occurs in children between 2 and 6 years of age and is benign, with complete recovery usually apparent within 6 weeks. The chronic form usually occurs in adults between 20 and 50 years of age. Recovery is rarely spontaneous and often requires adrenocortical steroids or splenectomy. Compare disseminated intravascular coagulation. See also hemophilia, hemorrhagic diathesis, idiopathic thrombopenic purpura, thrombasthenia.
observations Common manifestations include petechiae and ecchymoses on the skin, particularly the lower extremities; easy bruising; bleeding from the nose and gums; melena in stools; hematemesis; heavy menses and breakthrough bleeding; and hematuria. Jaundice, fever, and decreased levels of consciousness may be seen in thrombotic thrombocytopenic purpura. Diagnosis focuses on obtaining a history of bleeding symptoms and on ruling out other causes of thrombocytopenia, such as medications, ethanol abuse, HIV, or hematologic disorder. Lab findings include decreased platelet count. Bleeding time is prolonged, but coagulation time is normal. Capillary fragility is increased. Bone marrow aspiration shows an abundance of megakaryocytes. In thrombotic thrombocytopenic purpura there is severe anemia, elevated BUN, elevated creatinine, elevated reticulocytes, elevated LDH, decreased haptoglobin, and fragmented RBCs on peripheral smear. Platelet size and morphologic appearance may be abnormal in thrombotic thrombocytopenic purpura. Complications include hemorrhage into organs, such as the brain, gastrointestinal tract, or heart, which can be fatal without treatment.
interventions Medications that may be causing or contributing to the thrombocytopenia are discontinued. Treatment is determined by platelet count and bleeding status. Corticosteroids are used to enhance platelet production and promote capillary integrity. Immunosuppressants are used if the disease does not respond to steroids. Platelet transfusions are used in cases of severe bleeding in idiopathic thrombocytopenic purpura. Plasma exchange or plasmapheresis is the treatment of choice in thrombotic thrombocytopenic purpura. VinCRIStine may be used in thrombotic thrombocytopenic purpura cases that are refractory to plasmapheresis. Splenectomy may be considered for severe unresponsive thrombocytopenia. Immune globulin is given to prepare severely thrombocytic individuals for surgery. Platelet counts and bleeding episodes are monitored closely. Stool softeners are administered to prevent constipation.
nursing considerations Nursing goals are aimed at eliminating gross or occult bleeding, maintaining vascular integrity, decreasing risk for injury, and reducing complications. Safety precautions are instituted to prevent bruising (e.g., mouth swabs and soft bristle toothbrush for oral care; electric razor for shaving; insertion of IV access device for blood draws; padding bed rails and hard surfaces). Emesis, sputum, stool, urine, and other secretions for occult blood and pad counts during menstruation are frequently assessed and tested. Active bleeding is controlled with ice packs, gentle pressure, or packing. Rest and activity should be carefully balanced to conserve energy. Education is necessary about trauma prevention and safety precautions; avoidance of contact sports; avoidance of Valsalva's maneuver; the necessity for gentle coughing, sneezing, and nose blowing; and the necessity for increased fluid intake and balanced periods of rest and exercise. Instruction is given in infection precautions for those taking immunosuppressants. Education includes instruction to avoid anticoagulant over-the-counter medications, such as aspirin/aspirin products and other NSAIDs.
purpura (pur´pyoor
),n an extravasation of blood into the tissues, resulting in blue to black lesions of the skin or mucosa (petechiae and ecchymoses).
)
Purpura.
purpura, allergic,
n (anaphylactoid purpura) a thrombocytopenic or nonthrombocytopenic purpura related to an allergic reaction. Manifestations include the common symptoms of allergy.
purpura, anaphylactoid
n See purpura, allergic.
purpura, essential,
n See purpura, thrombocytopenic, idiopathic.
purpura hemorrhagica
n See purpura, thrombocytopenic and purpura, thrombocytopenic, idiopathic.
purpura, idiopathic thrombocytopenic,
n (essential purpura, land scurvy, primary purpura, purpura hemorrhagica) a type of unknown cause.
purpura, nonthrombocytopenic,
n a type related to increased capillary permeability. Included are allergic purpuras and those resulting from vitamin C deficiency, bacterial toxins (scarlet fever, typhoid), drug intoxications, and metabolic toxins (nephritis, liver disease).
purpura, primary,
n See purpura, thrombocytopenic, idiopathic.
purpura, secondary,
n See purpura, thrombocytopenic, symptomatic.
purpura, symptomatic thrombocytopenic,
n (secondary purpura) a type resulting from the effects of chemical, physical, vegetable, or animal agents or infections or related blood disorders.
purpura, thrombocytopathic
n a type associated with qualitative abnormalities of the platelets.
purpura, thrombocytopenic
n (essential thrombopenia, pseudohemophilia, hemorrhagica, Werlhof's disease) a type characterized by severe ecchymoses and petechiae associated with marked reduction in the numbers of blood platelets. There is prolonged bleeding time and poor clot retraction, but the coagulation and prothrombin times are normal. Hemorrhage may occur spontaneously from any area of the oral mucosa. This disease may be acute and fatal, whereas in other instances it may run a chronic course with intermittent attacks.
purpura, thrombotic thrombocytopenic,
n a febrile disease of unknown cause characterized by hemolytic anemia, neurologic symptoms, hemorrhage into the skin and mucous membranes, icterus, hepatosplenomegaly, low platelet count, and platelet thrombi occluding capillaries and arterioles.
purpura
a hemorrhagic disease characterized by extravasation of blood into the tissues, under the skin and through the mucous membranes, and producing spontaneous ecchymoses and petechiae on the skin. Similar lesions are produced in many specific diseases, e.g. epizootic hemorrhagic disease of deer, bracken poisoning in cattle, and leptospirosis in calves. In immune-mediated purpura there is a defect in the integrity of the vessel wall due to immunological mechanisms, which may also cause a thrombocytopenia.
anaphylactoid purpura
immune-mediated purpura; see also purpura.
fibrinolytic purpura
purpura associated with increased fibrinolytic activity of the blood.
purpura hemorrhagica
a well-defined disease of horses, occurring sporadically, usually associated with a respiratory tract infection. Clinical signs include cold, subcutaneous, edematous swellings, usually about the head and not always symmetrical, mucosal petechiation and high heart rate; affected horses commonly die within a few days. Nonthrombocytopenic.
neonatal purpura
alloimmune hemolytic anemia of the newborn in pigs is sometimes accompanied by a thrombocytopenic purpura, caused by antiplatelet antibodies. See also alloimmune thrombocytopenia.
nonthrombocytopenic purpura
purpura without any decrease in the platelet count of the blood. In such cases the cause of purpura is either abnormal capillary fragility or a clotting factor deficiency.
thrombocytopenic purpura
purpura associated with a decrease in the number of platelets in the blood. See also immune-mediated thrombocytopenia.
vascular purpura
that caused by loss of vascular integrity or function, as seen in vitamin C deficiency (scurvy), diabetes mellitus and hyperadrenocorticism.
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