see: [dunn petechiae](x-devonthink-item://85C991F4-8F70-4E65-92B8-0648430F0508) #paeds > **Petechiae appearance** > - flat round intradermal red spots <3mm in diameter > - represent capillary blood loss > - do not blanch with pressure > - more prominent in areas of high pressure > - in lower limbs or dependent areas > - under blood pressure cuffs - *palpable* suggests vasculitis - subacute bacterial endocatisi - rheumatoid arthritis - SLE - cryoglobulinaemia > [!treatment] DDx of petechiae > - *Viral*: eg enterovirus, adenovirus, dengue, EBV, CMV > - *Bacterial:* neisseria meningitidis, s pneumonias, GAS > - *Mechanical:* eg vomiting or coughing (occurs in distribution of SVC above the nipples), [[Non-accidental injury|NAI]] > - *Haematological:* aplastic anaemia, [[Von Willebrand disease|vWD]], [[DIC]], [[Haemolytic uraemic syndrome|HUS]] > - *Autoimmune:* SLE, [[haemolytic anaemia]] > - *Malignancy:* [[Leukemia|leukaemia]], MDS, [[Lymphoma]] > - *Immunity-related:* [[ITP]], [[HIV]], immune-deficiency > - *Drug-induced:* heparin-induced thrombocytopaenia, cephalosporins, aspirin > - Other : [[Henoch-Schonlein Purpura|HSP]] > > \* nb: this list is not comprehensive **Causes** [[thrombocytopaenia]] - platelet dysfunction - small vessel vasculitis - infection - [[Meningitis|meningococcal]] - [[measles]] - strep pyogenes - hep B and hep C - [[HIV]] - [[Dengue]] - [[Malaria]] - drugs - abx - thiazides - allopurinol - [[Warfarin, DOAC, heparin reversal|warfarin]] - NSAIDs (rarely) - scurvy - polarteritis nodosa - [[Henoch-Schonlein Purpura|HSP]] - serum sickness ![[Pasted image 20241112140524.png|Tardieu's spots: limited to areas of hypostasis / venous congestion as a result of mechanical rupture of s/c capillaries. seen in strangulation and hanging]] > **Ecchymosis** > - large area of confluent bleeding under the skin - thrombocytopenia - coagulation disorders - vitamin K def - anticoagulants - liver disease - [[Haemophelia]] - [[Von Willebrand disease]] - [[DIC]] # petechiae vs purpura ![[B8E6CD1A-7652-4564-9D83-72A4C5CCB5B2.jpeg]] - Petechiae are small (or “pinpoint”) non-blanching purpuric lesions < 2mm across - Purpura are larger non-blanching spots - Both petechiae and purpura do not blanch when pressure is applied - this is in contrast to other common rashes in children such as viral exanthems and urticaria - Majority of children with petechiae do not have a serious bacterial infection # management flow chart ![[Pasted image 20240304190836.jpg]] # Related Questions ## aids - [ ] 1Q: [AIDS](x-devonthink-item://A8F2D7A0-9A26-4012-AF42-19D640D674B4?page=6) -- [Answer](x-devonthink-item://A10DE51E-92FA-42D1-8AA0-7AE68C2FA743?page=2) ## anaemia - [ ] 2Q: [Anaemia](x-devonthink-item://DE6BF2B6-53E9-4530-BC75-C00EC806A473?page=11) -- [Answer](x-devonthink-item://D25C2F83-6C30-4F45-8B5B-6E7E57BD24A3?page=14) - [ ] 3Q: [Child with Anaemia](x-devonthink-item://2504F01B-CEAF-41E8-803B-B3AE1B07A49E?page=8) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=25) - [ ] 4Q: [Anaemia and Blood Transfusion](x-devonthink-item://662C8511-01CD-4659-B57D-5A01CF74D69B?page=12) -- [Answer](x-devonthink-item://79A95C0A-634E-4B38-9131-78949F63D56F?page=10) -- [prop](x-devonthink-item://F8FBC1E8-52B3-47B9-8EBB-5CB6F3F81EBC?page=13) - [ ] 5Q: [Referral for Blood Transfusion](x-devonthink-item://7061D1B4-0AB9-4963-B3B0-23BDD975B2CD?page=38) -- [Answer](x-devonthink-item://3F30C77E-E23E-4200-89FE-48A41618E0C2?page=26) - [ ] 6Q: [Abnormal FBC](x-devonthink-item://7E9EF652-F67B-42C5-A536-2EE85BA1954F?page=23) -- [Answer](x-devonthink-item://2DE5FACA-6D8F-41A2-8EAA-8DFE1E76FA61?page=14) - [ ] 7Q: [Fatigue with Abnormal FBC](x-devonthink-item://EB2A381E-D8D3-4236-B51F-2DF81CE08885?page=8) -- [Answer](x-devonthink-item://8455B512-D9BD-4314-927B-D3208619EE2A?page=8) - [ ] 8Q: [Anaemia](x-devonthink-item://8993893C-07A9-47B0-A68B-F8ED4C37C83D?page=18) -- [Answer](x-devonthink-item://C6A8980F-CAE5-458C-AC1E-FEBE553FDDE2?page=14) ## dic - [ ] 11Q: [Thrombocytopenia](x-devonthink-item://1A14F7A1-E434-47A6-BC68-AF2DD1A7C090?page=1) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=25) ## itp - [x] DUPLICATE Q: [Thrombocytopenia](x-devonthink-item://1A14F7A1-E434-47A6-BC68-AF2DD1A7C090?page=1) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=25) - [ ] 12Q: [Teenager with Petechial Rash](x-devonthink-item://078484BD-EA8D-4380-B88A-19048B494073?page=12) -- [Answer](x-devonthink-item://16D9B527-CEE4-41A5-B147-D3AE54CBF312?page=7) -- [prop](x-devonthink-item://3124817F-4CDF-46FB-993B-1501587D1E75?page=7) ## measles - [ ] 17Q: [Measles](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=52) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=33) -- [prop](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=66) - [ ] 18Q: [Unwell Child with Rash](x-devonthink-item://73409C77-B2FA-4E0A-AEB3-5EB284457F0C?page=55) -- [Answer](x-devonthink-item://5A848952-80E3-4184-B553-368412A69917?page=36) -- [prop](x-devonthink-item://2A1F4A99-92AE-4C8E-B325-AE448BD46AC6?page=13) ## meningitis - [ ] 19Q: [Possible meningitis](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=34) -- [Answer](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=36) - [ ] 20Q: [Meningitis](x-devonthink-item://C1DDA3AB-2DA2-4922-A8A6-F597AB7E2558?page=14) -- [Answer](x-devonthink-item://A10DE51E-92FA-42D1-8AA0-7AE68C2FA743?page=17) -- [prop](x-devonthink-item://B864660E-6598-4555-ACA9-B87F41ED4C3A?page=11) - [ ] 21Q: [Meningitis](x-devonthink-item://09CFA1A7-00F1-4151-979E-8F3984924D54?page=28) -- [Answer](x-devonthink-item://CF5E9C2B-42F9-4F9C-AC29-877E20134927?page=18) ## nai - [ ] 22Q: [Two year old not weight bearing](x-devonthink-item://4BE7EDE1-1843-4BA0-B8D2-0DCEF50784D4?page=7) -- [Answer](x-devonthink-item://15F8F701-8EC8-4F9A-8DEC-5220C8561C8A?page=6) -- [prop](x-devonthink-item://281EC7A9-8E5A-461A-AA34-3FF490AA0EC2?page=5) - [ ] 23Q: [Humerus fracture in 10 Month Old](x-devonthink-item://D466AD93-18B7-467C-BB6E-192EEBE26935?page=13) -- [Answer](x-devonthink-item://6F751245-A36C-447A-8AE7-599AD5871C71?page=5) -- [prop](x-devonthink-item://308BBEF4-A83E-4972-8F63-9249898FC8E8?page=4) ## neisseria meningitidis - [ ] 24Q: [Unwell Child with Rash](x-devonthink-item://0C18BB01-C981-4C61-B0E9-93B507919817?page=2) -- [Answer](x-devonthink-item://75D8E35B-EE77-4D1B-A665-438451C976AE?page=1) -- [prop](x-devonthink-item://E34679F3-102F-4E16-AF81-9D679412EDAC?page=2) ## ppe - [ ] 32Q: [MERS](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=12) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=6) ## rash - [ ] 33Q: [18 month old with rash](x-devonthink-item://09493372-578D-4C97-972A-EEC617B38B53?page=10) -- [Answer](x-devonthink-item://A0D348CE-FCD4-4ECD-BE21-6CA73F6DE8CD?page=4) - [ ] 34Q: [Painful rash](x-devonthink-item://80040649-2DDB-4266-9A7C-4DE4E6DD4AE6?page=9) -- [Answer](x-devonthink-item://C96EDD2F-137A-43E5-80EE-5F42C5971D55?page=13) -- [prop](x-devonthink-item://51B63B5B-D684-4BF3-8B62-95FCA5EF7503?page=11) - [x] DUPLICATE Q: [Measles](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=52) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=33) - [ ] 35Q: [Rash](x-devonthink-item://F0498813-9350-484C-AD5B-6FF7C3AE9015?page=12) -- [Answer](x-devonthink-item://A491A3F6-FD6D-492F-BCBE-7F7BAE101EDF?page=9) - [ ] 36Q: [Rash](x-devonthink-item://5DC0999B-D537-4002-86AF-FD7B54B45E2E?page=23) -- [Answer](x-devonthink-item://406AF611-5CD4-4B3B-9795-327E8F4E3626?page=8) - [ ] 37Q: [Child with Rash](x-devonthink-item://7FCD3940-4BB4-45FE-86A6-E5707E82D5B5?page=25) -- [Answer](x-devonthink-item://3263A68A-96A6-43EC-985B-43260C3509BF?page=8) - [ ] 38Q: [Kawasaki Disease](x-devonthink-item://84CE632D-3DD4-4F41-A900-23F41BE57287?page=1) -- [Answer](x-devonthink-item://D25C2F83-6C30-4F45-8B5B-6E7E57BD24A3?page=19) - [ ] 39Q: [Erythema Multiforme](x-devonthink-item://EE0B8625-5F19-46CF-8208-56D79DC48BC5?page=18) -- [Answer](x-devonthink-item://6F751245-A36C-447A-8AE7-599AD5871C71?page=17) -- [prop](x-devonthink-item://308BBEF4-A83E-4972-8F63-9249898FC8E8?page=12) - [ ] 40Q: [Child with Rash](x-devonthink-item://D6654B01-83AA-4553-94F0-791FD96A636D?page=15) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=8) -- [prop](x-devonthink-item://AB9BDA6D-9CA8-4E73-9D15-B6105225A1B4?page=4) - [x] DUPLICATE Q: [Unwell Child with Rash](x-devonthink-item://73409C77-B2FA-4E0A-AEB3-5EB284457F0C?page=55) -- [Answer](x-devonthink-item://5A848952-80E3-4184-B553-368412A69917?page=36) - [ ] 41Q: [Unwell Infant with Rash](x-devonthink-item://8993893C-07A9-47B0-A68B-F8ED4C37C83D?page=16) -- [Answer](x-devonthink-item://C6A8980F-CAE5-458C-AC1E-FEBE553FDDE2?page=12) -- [prop](x-devonthink-item://3124817F-4CDF-46FB-993B-1501587D1E75?page=5) ## thrombocytopenia - [x] DUPLICATE Q: [Thrombocytopenia](x-devonthink-item://1A14F7A1-E434-47A6-BC68-AF2DD1A7C090?page=1) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=25) - [ ] 42Q: [Child with fever and rash](x-devonthink-item://4BE7EDE1-1843-4BA0-B8D2-0DCEF50784D4?page=17) -- [Answer](x-devonthink-item://15F8F701-8EC8-4F9A-8DEC-5220C8561C8A?page=13) -- [prop](x-devonthink-item://281EC7A9-8E5A-461A-AA34-3FF490AA0EC2?page=7) - [ ] 43Q: [Thrombocytopenia](x-devonthink-item://FE3157C2-07B3-43F2-9ECE-AFACE1355E13?page=60) -- [Answer](x-devonthink-item://DDC959EB-0C1E-448A-8380-C397BF734322?page=29) - [ ] 44Q: [Thrombocytopenia](x-devonthink-item://5ADC62A1-9798-4399-BE79-68C375E8D9BF?page=4) -- [Answer](x-devonthink-item://6F751245-A36C-447A-8AE7-599AD5871C71?page=20) -- [prop](x-devonthink-item://308BBEF4-A83E-4972-8F63-9249898FC8E8?page=13) - [x] DUPLICATE Q: [Fatigue with Abnormal FBC](x-devonthink-item://EB2A381E-D8D3-4236-B51F-2DF81CE08885?page=8) -- [Answer](x-devonthink-item://8455B512-D9BD-4314-927B-D3208619EE2A?page=8)