Blood spots

Alternative names
Purpura; Skin hemorrhages

Definition
Purplish discolorations in the skin produced by small bleeding vessels near the surface of the skin. Purpura may also occur in the mucous membranes (such as the lining of the mouth) and in the internal organs.

Considerations
Purpura by itself is only a sign of other underlying causes of bleeding.

When purpura spots are very small, they are called petechiae. Large purpura are called ecchymoses.

Purpura may occur with either normal platelet counts (nonthrombocytopenic purpuras) or decreased platelet counts (thrombocytopenic purpuras). Platelets help maintain the integrity of the capillary lining and are important in the clotting process.

Common Causes
Conditions that cause purpura are grouped into two categories: nonthrombocytopenic and thrombocytopenic. Some common purpuras include:

NONTHROMBOCYTOPENIC PURPURAS

• pressure changes associated with vaginal delivery of an infant
  
• vasculitis such as Henoch-Schonlein purpura (anaphylactoid purpura)
  
• congenital cytomegalovirus
  
• congenital rubella syndrome (changes in the baby that can occur when a pregnant woman has rubella)
  
• drug-induced platelet dysfunction (some drugs can affect the action of platelets)
  
• senile purpura (the blood vessels become more fragile as a person ages)

• idiopathic thrombocytopenic purpura (ITP)
  
• immune neonatal thrombocytopenia (a disorder that can occur in infants whose mothers have ITP)
  
• platelet consumption in hemangioma
  
• drug-induced thrombocytopenia (some drugs can prevent the formation of platelets)
  
• meningococcemia (an infection caused by meningococcus bacteria)

Any new purpura should be brought to your physician’s attention.

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting purpura may include:

• time pattern
  o Is this the first time you have had spots such as these?
  o When did they develop?
  
• type
  o Petechiae (small purplish or reddish dots)?
  o Ecchymoses (look like bruises)?
  
• other
  o What medications are being taken?
  o What other medical problems have you had?
  o Does anyone in your family have similar spots?
  o What other symptoms are also present?

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