Purpura

Purpura

Purpura (in Latin word, purpura, meaning purple) the appearance of red or purple discolorations skin, caused by bleeding underneath the skin. This can create purple spots on the skin that range in size from small spots such as petechiae and large sp (< 1 ) ecchymosis (> 1 cm). The spots are generally benign, but may indicate a more serious medical condition, such as blood clotting disorder, infection, rubella etc. 

Classification according to etiology

• Platelet disorders (Thrombocytopenic purpura)
• Vascular disorders (Nonthrombocytopenic purpura

1. Microvascular injury - senile (old age) purpura when blood vessels are more easily damaged
2. Hypertensive states
3. Vasculitis -Henoch-Schönlein purpura

• Coagulation disorders

1. Disseminated intravascular coagulation (DIC)
2. Scurvy - defect in collagen synthesis due to lack hydroxylation of procollagen. It results a weakened capillary walls and cells.

Signs and Symptoms

• Bruising, petechiae Nosebleeds, bleeding gums
• Subarachnoid, intracerebral hemorrhage or other internal bleeding if platelets count below 20,000

Diagnosis

• History of infection, drugs e.g. quinine, heparin
• Physical examination-skin, spleen etc
• Blood test-BT, CT, aPTT, platelets count, TC, DC, ESR
• Bone marrow examination

Treatment

• Steroids therapy for 2-6 weeks to increase platelet count by decreasing the activity of immune system of the patient
• Immunoglobulin to increase platelet count
• Splenectomy if medical management is not effective for the control of condition.
• Platelets transfusion

Nursing Interventions

• Control bleeding:

1. Administer platelet transfusion as prescribed
2. Apply pressure to bleeding site as needed
3. Position bleeding part above the heart level if possible

• Prevent bruising
• Provide support to client and be sensitive to change in body image
• Provide teaching about the prevention of bruising and bleeding
• Administer analgesic as prescribed, avoid aspirin
• Measure the normal circumference and extremities for baseline
• Avoid l / M injection as much as possible
• Protect from infection