purpura senilis

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purpura
[perpu-rah]
a hemorrhagic disease characterized by extravasation of blood into the tissues, under the skin,
and through the mucous membranes, and producing spontaneous bruises, ecchymoses, and
petechiae (small hemorrhagic spots) on the skin. (See plate in Dermatology Atlas.) When
accompanied by a decrease in the circulating platelets, it is called thrombocytopenic purpura;
when there is no decrease in the platelet count, it is called nonthrombocytopenic purpura.
adj., adj purpuric.

There are two general types of thrombocytopenic purpura: primary or idiopathic, in which
the cause is unknown, and secondary or symptomatic, which may be associated with
exposure to drugs or other chemical agents, systemic diseases such as multiple myeloma and
leukemia, diseases affecting the bone marrow or spleen, and infectious diseases such as
rubella (German measles).
SYMPTOMS. The outward manifestations and laboratory findings of primary and secondary
thrombocytopenic purpura are similar. There is evidence of bleeding under the skin, with
easy bruising and the development of petechiae. In the acute form there may be bleeding
from any of the body orifices, such as hematuria, nosebleed, vaginal bleeding, and bleeding
gums. The platelet COUNT is below 100,000 per cubic millimeter of blood and may go as low
as 10,000 per cubic millimeter (normal count is about 250,000 per cubic millimeter). The
bleeding time is prolonged and clot retraction is poor. Coagulation time is normal.
TREATMENT. Differential diagnosis is necessary to determine the type of purpura present and
to eliminate the cause if it can be determined. General measures include protection of the
patient from trauma, elective surgery, and tooth extractions, any one of which may lead to
severe or even fatal hemorrhage. In the thrombocytopenic form, corticosteroids may be
administered when the purpura is moderately severe and of short duration. Splenectomy is
indicated when other, more conservative measures fail and is successful in a majority of
cases. In some instances, especially in children, there may be spontaneous and permanent
recovery from idiopathic purpura. (See Atlas 2, Part Q.)
allergic purpura (anaphylactoid purpura) Henoch-Schnlein purpura.
annular telangiectatic purpura a rare form in which pinpoint reddened lesions coalesce to
form a ring-shaped or continuously linked pattern, commonly beginning in the lower
extremities and becoming generalized. Called also Majocchi's disease.
fibrinolytic purpura purpura associated with increased fibrinolytic activity of the blood.
purpura fulminans a form of nonthrombocytopenic purpura seen mainly in children,
usually after an infectious disease, marked by fever, shock, anemia, and sudden, rapidly
spreading symmetrical skin hemorrhages of the lower limbs, often associated with extensive
intravascular thromboses and gangrene.
purpura hemorrhagica primary thrombocytopenic purpura.
Henoch's purpura a type of Henoch-Schnlein purpura in which abdominal symptoms
predominate.
Henoch-Schnlein purpura a type of nonthrombocytopenic purpura, of unknown cause but
thought to be due to a vasculitis; it is most often seen in children and is associated with
clinical symptoms such as urticaria and erythema, arthritis and other joint diseases,
gastrointestinal symptoms, and renal involvement. Called also Schnlein-Henoch purpura or
syndrome and allergic or anaphylactoid purpura.
idiopathic thrombocytopenic purpura thrombocytopenic purpura not directly associated
with any definable systemic disease, although it often follows a systemic infection; the cause
is thought to be an IgG immunoglobulin that acts as an antibody against platelets, causing
ecchymoses, petechiae, and other bleeding. There are both acute and chronic forms: the acute
form has a sudden onset, is more common in children, and usually resolves spontaneously
within a few months; the chronic form has a slower onset, is more common in adults, and
may be recurrent.
nonthrombocytopenic purpura purpura without any decrease in the platelet count of the
blood. In such cases the cause is either abnormal capillary fragility or a clotting factor
deficiency.
Schnlein purpura a type of Henoch-Schnlein purpura in which articular systems
predominate; called also Schnlein's disease.
Schnlein-Henoch purpura Henoch-Schnlein purpura.
purpura senilis dark purplish red ecchymoses occurring on the forearms and backs of the
hands in the elderly.
thrombocytopenic purpura purpura associated with a decrease in the number of platelets in
the blood; see PURPURA.
thrombotic thrombocytopenic purpura a form of thrombotic MICROANGIOPATHY
characterized by THROMBOCYTOPENIA, HEMOLYTIC ANEMIA, bizarre neurological
manifestations, UREMIA (AZOTEMIA), fever, and thromboses in terminal arterioles and
capillaries; some authorities consider it identical to the HEMOLYTIC UREMIC SYNDROME.
Called also microangiopathic hemolytic anemia and Moschcowitz's disease.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh
Edition. 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.