Diagnostic approach to the febrile child with petechiae in the emergency department

Careful evaluation of any child with petechiae and purpura is important to facilitate rapid diagnosis and treatment, particularly in children who are ill-appearing or febrile. In children with fever and purpuric skin lesions, especially petechiae and/or purpura, serious infection with sepsis and disseminated intravascular coagulation require rapid recognition and treatment. The type, location, and extent of the lesions, along with the overall appearance of the child, will help to guide the initial evaluation and suggest the underlying cause. This algorithm is intended for use with other UpToDate content; refer to UpToDate content on evaluation and causes of purpuric lesions (petechiae, purpura, and ecchymoses) in children.

CBC: complete blood count; CRP: C-reactive protein; PT: prothrombin time; INR: international normalized ratio; PTT: partial thromboplastin time; WBC: white blood cell count; ANC: absolute neutrophil count; DIC: disseminated intravascular coagulopathy; HUS: hemolytic uremic syndrome; TTP: thrombotic thrombocytopenic purpura.

* Concerning features on CBC and peripheral smear include but are not limited to:

Elevated WBC with predominant polymorphonucleocytes
Elevated ANC
Neutropenia (ANC <1500/microL)
Lymphoblasts
Anemia with thrombocytopenia
Pancytopenia
Schistocytes on peripheral smear

¶ Empiric antimicrobial treatment should consist of broad spectrum antibiotics and, for susceptible patients, antifungal and antiviral agents. For specific regimens, initial resuscitation, and early management of sepsis with DIC, refer to UpToDate topics on recognition and initial resuscitation of sepsis or septic shock in children.

Graphic 141375 Version 1.0

خرید پکیج

Diagnostic approach to the febrile child with petechiae in the emergency department