Purpura in Children

By | 1 June, 2016

The differential diagnosis of purpura in children depends about two considerations: (1) Does the patient look ill? and (2) What is the platelet count?

Henoch–Schönlein purpura

Non-blanching purpura of the left flank and buttock in an eight-year-old boy with Henoch–Schönlein purpura (from https://openi.nlm.nih.gov/detailedresult.php?img=PMC1847827_1752-1947-1-6-3&req=4)

Here’s how it goes:

Appearance Platelet Count Causes
Sick Low Meningococcemia, Leukemia, DIC, Hemolytic-Uremic Syndrome (HUS)
Sick Normal or High (*) Viremia (e.g., EBV), Vasculitis (e.g., Mucocutaneous lymph node syndrome [Kawasaki])
Well Low Immune Thrombocytopenic Purpura (ITP), Wiscott-Aldrich, Aplastic anemia
Well-ish Normal Henoch–Schönlein purpura, Vomiting or coughing (if in SVC distribution)
(*) But still always consider meningococcemia in any sick child with purpura, with or without thrombocytopenia!
Reference: Oxford Handbook of Clinical Specialties, 9e (2013).
Author: Mark Yoffe, MD

Mark Yoffe is a practicing internal medicine doctor who writes about medical books and education.

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