Purpura (from Latin: purpura, meaning "purple") is the appearance of red or purple discolorations on the skin that do not

blanch on applying pressure. They are caused by bleedingunderneath the skin. Purpura measure 0.31 cm (310 mm), whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.[1] This is common with typhus and can be present with meningitis caused by meningococcalmeningitis or septicaemia. In particular, meningococcus, a Gram-negative diplococci organism, releases endotoxin when it lyses. Endotoxin activates the Hageman factor (clotting factor XII), which causes disseminated intravascular coagulation. The DIC is what appears as a rash on the affected individual.

Classification
Purpura is a common and nonspecific medical sign; however, the underlying mechanism commonly involves one of the following:

Platelet disorders (Thrombocytopenic purpura) Primary thrombocytopenic purpura Secondary thrombocytopenic purpura Post-transfusion purpura Vascular disorders (Nonthrombocytopenic purpura) Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged Hypertensive states Deficient vascular support Vasculitis, as in the case of Henoch-Schnlein purpura Coagulation disorders Disseminated intravascular coagulation (DIC) Scurvy (vitamin C deficiency) - defect in collagen synthesis due to lack of hydroxylation of procollagen. It results in weakened capillary walls. Meningococcemia

There are also cases of psychogenic purpura described in the medical literature,[2] some claimed to be due to "autoerythrocyte sensitization." Other studies[3] suggest, that local (cutaneous) activity of tPA can be increased in psychogenic purpura, leading to substantial amounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding. Petechial rash is also characteristic of arickettsial infection.

What Is Idiopathic Thrombocytopenic Purpura?

Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets (PLATE-lets). Platelets also are called thrombocytes (THROM-bo-sites). They're made in your bone marrow along with other kinds of blood cells. Platelets stick together (clot) to seal small cuts or breaks on blood vessel walls and stop bleeding. "Idiopathic" (id-ee-o-PATH-ick) means that the cause of the condition isn't known. "Thrombocytopenic" (throm-bo-cy-toe-PEE-nick) means there's a lower than normal number of platelets in the blood. "Purpura" (PURR-purr-ah) refers to purple bruises caused by bleeding under the skin.

Overview
People who have ITP often have purple bruises that appear on the skin or on the mucous membranes (for example, in the mouth). The bruises mean that bleeding has occurred in small blood vessels under the skin. A person who has ITP also may have bleeding that results in tiny red or purple dots on the skin. These pinpoint-sized dots are called petechiae (peh-TEE-keeay). Petechiae may look like a rash.

Petechiae and Purpura

The photograph shows petechiae (red/purple dots) and purpura (bruises) in the skin. Bleeding under the skin causes the purple, brown, and red color of the petechiae and purpura. People who have ITP also may have nosebleeds, bleeding from the gums when they have dental work done, or other bleeding that's hard to stop. Women who have ITP may have menstrual bleeding that's heavier than usual. More extensive bleeding can cause hematomas (he-mah-TO-mas). A hematoma is a collection of clotted or partially clotted blood under the skin. It looks or feels like a lump. Bleeding in the brain as a result of ITP is very rare, but can be life threatening if it occurs. In most cases, an autoimmune response is believed to cause ITP. Normally your immune system helps your body fight off infections and diseases. But if you have ITP, your immune system attacks and destroys its own platelets. The reason why this happens isnt known. ITP can't be passed from one person to another.

Types of Idiopathic Thrombocytopenic Purpura

There are two types of ITP: acute (temporary or short-term) and chronic (longlasting). Acute ITP generally lasts less than 6 months. It mainly occurs in children, both boys and girls, and is the most common type of ITP. Acute ITP often occurs after an infection caused by a virus. Chronic ITP is long-lasting (6 months or longer) and mostly affects adults. However, some teenagers and children can get this type of ITP. Chronic ITP affects women 2 to 3 times more often than men. Treatment depends on how severe the bleeding symptoms are and the platelet count. In mild cases, treatment may not be needed.

Outlook
For most children and adults, ITP isn't a serious or life-threatening condition. Acute ITP in children often goes away on its own within a few weeks or months and doesn't return. In 80 percent of children who have ITP, the platelet count returns to normal within 6 to 12 months. Treatment may not be needed. A small number of children, about 5 percent, whose ITP doesn't go away on its own may need to have further medical or surgical treatment. Chronic ITP will vary with each individual and can last for many years. Even people who have severe forms of chronic ITP can live for decades. Most people who have chronic ITP are able at some point to stop treatment and keep a safe platelet count.

Idiopathic Thrombocytopenic Purpura (ITP)

What is ITP?
ITP stands for idiopathic thrombocytopenic purpura. "Idiopathic" means that the cause of the condition is unknown. "Thrombocytopenic" means the blood doesn't have enough platelets (platelets are also called

thrombocytes). "Purpura" means a person has excessive bruising. ITP is also sometimes called "immune thrombocytopenic purpura." In people who have ITP, all of the blood cells are normal except for the platelets. Platelets are the tiny cells that form blood clots and seal minor cuts and wounds. A person who has too few platelets bruises very easily and can bleed for a long time after being injured. When the platelet count is very low, a person who has ITP might have nosebleeds that are hard to stop, or they might have bleeding in the intestines, or even bleeding in the brain with minor trauma. Return to top

What are the symptoms of ITP?

The symptoms of ITP include: Easy or excessive bruising Petechiae (tiny reddish purple dots on the skin that are caused by bleeding under the surface of the skin) on the body, especially on the lower legs Cuts or minor wounds that take a very long time to clot or stop bleeding Blood in the urine or stools Unusually heavy menstrual flow in women Unexplained bleeding from the nose or gums

What causes ITP?

The cause of ITP is not known. People who have ITP form antibodies that destroy their blood platelets. Normally, antibodies are a healthy response to bacteria or viruses. In people who have ITP, however, the antibodies attack the body's own blood platelets. Return to top

How is ITP diagnosed?

Your doctor can begin to diagnose ITP by asking questions about your health and doing a physical exam. Your doctor may take a blood sample for a test that counts blood cells and platelets (called a CBC) or look at it under a microscope (called a blood smear). Your doctor may also want you to get a bone marrow exam to rule out other possible causes of your symptoms. Return to top

Who gets ITP?

There are 2 types of ITP. One type affects children, and the other type affects adults. In children, the usual age for getting ITP is 2 to 4 years of age. Most adults with ITP are young women, but it can occur in anyone. ITP does not seem to be hereditary (run in families). ITP is not contagious (you cant catch it from someone else). Return to top

How does ITP affect children?

ITP in children is usually mild and runs it course without the need for treatment. About 80% of children recover completely from ITP within about 6 months.

Return to top

How is ITP treated in children?

Because most children recover with no treatment, many doctors recommend just watching them carefully and taking care of the bleeding symptoms. Children don't have to go to the hospital if good care is available at home. However, some doctors recommend a short treatment with prednisone pills or intravenous infusions (given in a vein) of gamma globulin to increase the platelet count more quickly. Both medicines have some side effects. Return to top

How does ITP affect adults?

In most adults, ITP lasts much longer than it does in children. At the time of diagnosis, most adults have noticed increased bleeding and easy bruising for several weeks or even months. In women, increased menstrual blood flow is a common sign. Many adults have only mild thrombocytopenia. In fact, quite a few people have no bleeding symptoms. They are only diagnosed with ITP when their blood is checked for another reason and a low blood platelet count is found. Mild cases of ITP may not require treatment, just regular monitoring of the platelet levels. Return to top

How is ITP treated in adults?

Treatment of ITP in adults is aimed at increasing the blood platelet count. This is not the same as curing the disease. Your doctor may recommend that you get high doses of immune globulin (through a needle). Some patients might take prednisone for several weeks or months. Prednisone raises the level of your platelet count. As your count rises and reaches a safe level, your doctor may gradually decrease your medicine until you no longer take the prednisone. However, when the medicine is stopped, your platelet count may decrease again. If prednisone doesn't help enough, your doctor may recommend that your spleen be removed. The spleen makes most of the antibodies that destroy the blood platelets. It also destroys old or damaged blood cells. In an otherwise healthy person, removal of the spleen is not a serious operation. Laparoscopic removal of the spleen is now possible, further reducing surgical risk. However, this treatment is done less often than it once was. Removing the spleen will permanently reduce your bodys ability to fight infection. Some people can also relapse (have the condition return) even after the spleen is removed. Other treatments for ITP include another kind of steroid medicine called danazol or other medicines that work to hold the immune system in check, such as rituximab. Some people with certain blood types may have anti-RhD therapy, which is a shot or series of shots that also work to reduce antibodies in the blood. Another option includes filtering antibodies from the blood. Return to top

What about ITP in pregnant women?

Many of the medicines used to treat ITP should not be taken by women who are pregnant. Talk to your doctor if you are taking medicine and want to become pregnant.

Diagnosing ITP during pregnancy can be difficult, because platelet counts may be low for other reasons. About 5% of women have mildly low platelet counts at the end of a normal pregnancy. The cause of this is unknown. The platelet count goes back to normal right after delivery. A baby born to a mother who has ITP may have a low blood platelet count a few days to a few weeks after birth. These babies are usually kept in the hospital for several days for observation (watching to make sure they are okay) before they go can home. If the baby's platelet count is very low, treatment is available to speed recovery. Return to top

What can I do if I have ITP?

If you have ITP, you should avoid medicines that increase risks for bleeding, such as warfarin (a medicine often used to treat an abnormal heart rhythm called atrial fibrillation) and over-the-counter drugs like aspirin and ibuprofen (some brands: Advil, Motrin). You should also limit alcohol because it can decrease the ability of your blood to clot.