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Algorithm for Diagnosis of the Petechial / Purpuric Rash

Febrile/Toxic, Palpable: 
 - Meningococcaemia, Disseminated Gonococcal Infection,
Febrile/Toxic, Palpable ... DIC, Thrombotic Thrombocytopaenic ... /Non-Toxic, Palpable ... Non-Toxic, Non-palpable ... - Idiopathic Thrombocytopaenic
Petechial/Purpuric Rashes- THE ALGORITHMIC APPROACH 

These rashes can be especially challenging and are
associated with devastating differential
the etiology of palpable ... Palpable (raised ... presents in thrombocytopenic ... have idiopathic thrombocytopenic ... likely to have thrombocytopenia
Causes of Purpura - Differential Diagnosis
Non-PalpabIe → Palpable
 • Thrombocytopenia (HIT, ITP/HUS), Coagulation defects (DIC, warfarin
Causes of Purpura ... Diagnosis Non-PalpabIe ... → Palpable • ... Thrombocytopenia ... BrighamChiefs #Purpura
Causes of Purpura - Differential Diagnosis
Disruption in Vascular Integrity: 
 • Trauma, Infection, Vasculitis, Drug induced
Causes of Purpura ... C), Pigmented purpuric ... Primary hemostasis: Thrombocytopenia ... BrighamChiefs #Purpura ... #nonpalpable #palpable
Purpura - Differential Diagnosis Framework

Non-blanchable, dark red to purple, hemorrhagic skin lesions that result from leakage
inflammation • Thrombocytopenia ... CAUSES OF NON-PALPABLE ... Primary Causes: - Thrombocytopenia ... syndrome CAUSES OF PALPABLE ... #rheumatology #palpable
Henoch Schonlein Leg Rash - Palpable Purpura
Purpura: Low Platelets or Vasculitis?
45 years old, seen in our
Schonlein Leg Rash - Palpable ... Purpura Purpura ... Palpable purpura ... differentiate Thrombocytopenia ... Palpable = vasculitis
Causes of Petechial Rash - Differential Diagnosis Algorithm

Pinpoint areas (less than 2 mm) of hemorrhage, which
hemostasis: - Thrombocytopenia ... Toxic Patient: • Palpable ... Henoch Schonlein Purpura ... Endocarditis • Non-Palpable ... Rash: - Purpura
Disseminated Intravascular Coagulation (DIC) Overview

Increased Clotting and Consumption of Clotting Factors

Findings:
 • Bleeding
 • Recent history
transfusion • Thrombocytopenia ... Petechiae • Purpura ... • Palpable variants ... Hemorrhagic bullae • Purpura ... coagulopathy - Thrombocytopenia
Bleeding manifestations 
Petechiae are small, flat, red, discrete areas of skin bleeding that are typically <2
areas of the body Purpura ... is usually palpable ... Wet purpura is the ... individuals with thrombocytopenia ... Bruise #ecchymosis #thrombocytopenia
Algorithm - Approach to the differential diagnosis of the patient presenting with overt glomerular proteinuria. CMV
TTP = thrombotic thrombocytopenic ... purpura. ... skin (alopecia, purpura ... , palpable purpura