Bleeding disorders

Sudden onset of palpable purpura ( localized, raised hemorrhages in the skin ) in association with rash and fever may be caused by vasculitis ( septic or aseptic ). Septic vasculitis may be caused by meningococcemia or other bacterial infections associated with thrombocytopenia and prolong Clotting time.

Henoch-Scholein purpura  Aseptic vasculitis in young adults and adolesents.  Involving the skin, GI tract and kidneys.  Accompanied by abdominal pain ( due to bleeding into bowel wall ).  Usually occur after a viral infection.  Due to IgA hypersensitivity reaction.

Treatment of bleeding from vascular disease  Senile and steroid induce purpura no treatment.  Scurvy oral ascorbic acid.  Congenital disease ---- avoid drugs may cause bleeding such as aspirin, iron supplement.  Hereditary H teleng systemic administration of estrogen may help to decrease epistaxis by inducing metaplasia of nasal mucosa and protect lesions from trauma.

 septic vasculitis antibiotics  Aseptic vasculitis steroid / or immunosuppressive agents.

Thrombocytopenia caused by peripheral platelet distruction :  immune mechanism  Nonimmune mechanism

Treatment 1) Steroid ( prednisolone ) 1-2mg / kg / day 2) Platelet transfusion are not generally used because transfused plat survival is brief and bleeding complications are uncommon, however, in significant bleeding or the need for surgery, plat transfusions are indicated to increase transiently the plat count ( usually < 24 hr).

3- in severe thrombocytopenia ( <5000/mic l ) or life threatening bleeding, high dose methylprednisolon ( 1g/d for 3 days ) alone or with IVIG 2 g/kg in divided doses over 2-5 days ).