Version June 2024
| Complete blood count with differential, platelet count, and blood smear |
Polycythemia or anemia, granulocytosis, thrombocytosis, poikilocytosis
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Evidence of red cell fragmentation (schistocytes) and microangiopathy, consider:
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Thrombocytopenia, consider:
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Severe neutropenia
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Eosinophilia
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| Partial thromboplastin time |
| Minimally prolonged in TTP-hemolytic uremic syndrome |
| Prolonged in purpura fulminans and DIC |
| Prolonged if lupus anticoagulant activity present, and assay sensitive |
| Cryoglobulins (occasionally cryofibrinogen and cold agglutinins) when location and history suggest cold occlusion syndrome |
| Biopsy |
| Confirms occlusion versus other mechanisms of vessel injury |
| May suggest platelet plugs instead of fibrin thrombi |
| May suggest cryoglobulin gelling |
| May diagnose calciphylaxis |
| May suggest cholesterol, oxalate, or crystal globulin occlusion |
| Special stains for organisms in immunocompromised hosts, when appropriate |
| Basic hepatic and renal function screens |
| Hepatic function can affect vitamin K-dependent factors and warfarin metabolism |
| Renal disease moves cutaneous calciphylaxis higher in the differential diagnosis |
| ANCA |
| To reduce the likelihood of the uncommon noninflammatory retiform purpura presentation of granulomatosis with polyangiitis (Wegener's granulomatosis) or microscopic polyangiitis |
| ANCA may be available before permanent histologic sections |
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