Version June 2024
| Etiology | Characteristic signs and symptoms |
| A. Disorders of blood vessels and surrounding tissue | |
| Idiopathic* | Bruises typically found on upper arms and legs, more common in women |
| Physical abuse* | Bruises that pattern after objects, in nonmobile subjects, a history inconsistent with patient's injuries |
| Aging (senile purpura)* | Dark ecchymosis in aged, thin skin; typically over extensor surfaces of forearms |
| Glucocorticoids* | Patients at risk with long-term use (eg, polymyalgia rheumatica) |
| Alcohol abuse* | History of heavy alcohol intake; signs of cirrhotic liver disease |
| Wasting, malnutrition* | Dietary history, cachetic on examination |
| Hypercortisolism, Cushing's syndrome | Supraclavicular fat pads, skin atrophy, wide purplish striae, and proximal muscle weakness |
| Ehlers-Danlos syndrome | Hypermobility of joints; skin hyperelasticity |
| Pseudoxanthoma elasticum | Characteristic skin findings: 2 to 5 mm yellow to orange papules |
| Amyloidosis | Multiple manifestations depending on type of amyloidosis |
| Hereditary hemorrhagic telangiectasia | Mucocutaneous telangiectasias and gastrointestinal arteriovenous malformations |
| Vitamin C deficiency (scurvy) | Dietary history; dental deterioration, impaired wound healing, coiled hairs |
| Marfan syndrome | Tall and thin; stretch marks; pectus excavatum; mitral valve prolapse; dilated aortic root |
| Osteogenesis imperfecta | Short stature, multiple fractures, increased laxity of ligaments and skin |
| Connective tissue disease, cryoglobulinemia, or vasculitis (eg, immunoglobulin A vasculitis [Henoch-Schönlein purpura]) | Systemic symptoms, presence of palpable purpura |
| B. Platelet abnormalities | |
| Drugs* | Possible temporal relationship to symptom onset |
| Renal disease* | Decreased glomerular filtration rate |
| Autoimmune disorders | Multi-system disease including joint inflammation, abnormal antibody testing |
| Von Willebrand disease* (VWD) | Reduced von Willebrand factor (VWF) antigen and ristocetin cofactor |
| Leukemia | Abnormal complete blood count, peripheral smear, and bone marrow biopsy |
| Lymphoid malignancy | Lymphadenopathy |
| May-Hegglin anomaly | Autosomal dominant trait characterized by mild bruising/bleeding |
| Thrombocytopenia Absent Radius (TAR) syndrome | Autosomal recessive disorder with severe thrombocytopenia and absent radii bones |
| Storage pool disease | Bleeding after trauma or surgery |
| Bernard-Soulier syndrome | Autosomal recessive disorder leading to absence of platelet glycoprotein Ib-IX-V, circulating giant platelets, immediate bleeding (not delayed bleeding as in coagulation disorders) |
| Glanzmann thrombasthenia | Autosomal recessive disorder leading to absence of platelet glycoprotein IIb/IIIa, circulating giant platelets; no platelet clumping on platelet aggregation studies |
| Gaucher disease | Autosomal recessive disorder presenting in childhood with varying symptoms depending on type 1, 2, 3a, 3b, or 3c |
| Wiskott-Aldrich syndrome | X-linked disorder characterized by hemorrhagic diathesis, recurrent infection, extensive eczema |
| Myeloproliferative disorders | Abnormal bone marrow biopsy with increased platelets and positive for JAK 2 |
| C. Coagulation protein disorders | |
| Liver disease* | History of alcohol abuse, modestly-elevated liver function tests, hepatomegaly, ascites, stigmata of chronic liver disease (spider angiomata, palmar erythema, gynecomastia) |
| Vitamin K deficiency, warfarin therapy* | Antibiotic administration, poor nutritional status, vitamin K binding drugs (cholestyramine) |
| Hemophilia (factor VIII, IX, deficiency) | Males affected, family history, delayed bleeding |
| Circulating anticoagulant or inhibitor | Similar to hemophilia but onset is sudden and no patient or family history |
| Dysfibrinogenemia | Diagnosis of exclusion, identified with fibrinogen tests |
| Plasminogen activator deficiency or inhibitor | Delayed bleeding |
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