Skin bleeding

Introduction Extensive or localized skin and submucosal hemorrhage, forming red or dark red spots on the skin and mucous membranes, about 3-5 mm in diameter or larger, and the fading of the pressure is called purpura. Usually the diameter within 2 mm is called the bleeding point. Red blood spots on the body are usually caused by irritated telangiectasia or rupture of the skin. Some people are sensitive to natural skin and encounter irritants such as frozen. When they are exposed to spicy skin, they will have red blood spots, but they will disappear after a while, so don't worry too much. If you appear multiple times without being stimulated, you should go to the hospital for treatment, because it is very likely to be a sign of chronic serious illness.

Cause

(1) Extravascular factors: If the perivascular tissue is weak due to degeneration, atrophy and relaxation, it is prone to bleeding and form purpura. Extravascular factors are more common in senile or cachexia purpura. Capillaries and small blood vessels are slightly affected by a slight external force, which can cause rupture and hemorrhage.

(2) Vascular factors: refers to the purpura formed by the leakage of blood from the blood vessels to the outside of the blood vessels due to damage of the capillary wall. Purpura caused by vascular factors accounted for the first place in all purpura. After a small blood vessel injury in a normal person, the blood vessel immediately undergoes a reflex contraction, and the local blood flow is slowed down to promote hemostasis. If the peripheral blood vessels are brittle, the permeability is increased, and the vasomotor function is abnormal, it is easy to cause hemorrhagic purpura due to extravasation of blood from the blood vessels. The hemorrhage caused by vascular factors is characterized by capillary fragility test, but the bleeding time and clotting time are normal. The most common form of such purpura is allergic purpura. Second, bacterial or viral infections, vitamin C deficiency, chemical factors, etc. can cause damage to the blood vessel wall and cause purpura. In addition, there is an unclear increase in the brittleness of the blood vessel wall, which is common in women. The purpura can disappear on its own and has no adverse consequences. It is called simple purpura.

(3) Platelet factors: Platelets play an important role in the process of hemostasis. Thrombocytopenia or defects in platelet function may result in decreased or lost hemostasis, and are prone to purpura. Thrombocytopenia can be seen in idiopathic thrombocytopenia, secondary thrombocytopenia (also known as symptomatic purpura, thrombocytopenia due to bone marrow hematopoietic disorders, seen in aplastic anemia, leukemia, cancerous bone metastasis), radiation Substances and chemicals destroy megakaryocytes, which reduce platelet production and severe infections (such as typhoid fever, meningitis, sepsis) and excessive platelet destruction. In addition, hypersplenism, lupus erythematosus, uremia, etc. can also reduce thrombocytopenia. Platelet function-deficient diseases include hemorrhagic thrombocytosis and thrombocytopenia. Laboratory tests are important for the diagnosis of purpura caused by platelet factors, generally characterized by prolonged bleeding time, poor clot retraction and thrombocytopenia.

(4) Coagulation factor: Coagulation factor deficiency often causes coagulopathy and causes purpura. These diseases are rare, the causes are mostly congenital, and a few are acquired (mainly caused by liver disease). Patients with purpura should be examined for blood routine, platelet count, bleeding time, clotting time, capillary fragility test, skin and mucous membrane microcirculation, hemorheology and coagulation factors.

an examination

Related inspection

Blood routine ribonucleic acid staining urine concentration dilution test urinary fibrin degradation products

Laboratory inspection

(1) The beam arm test is positive or negative, but the routine examination of hemostasis function is normal.

(2) In a small number of patients, platelets are abnormal in ADP and adrenaline-induced aggregation, and the adhesion rate to the bead column is reduced.

Differential diagnosis

Spontaneous mild skin imperfections or ecchymoses: mainly in the lower limbs, occasionally in the upper limbs, but rarely in the trunk, no predisposing factors. Freckles or sputum are not the same size, uneven distribution, no higher than the surface, the pressure does not fade and does not hurt. There may be slight pain in the local area before the appearance of ecchymosis. Often, when the clothes are dressed in the morning of the next morning, the skin of the legs is consciously painful, and ecchymoses are found during the examination. Without treatment, the ecchymoses can resolve on their own, leaving a yellow-yellow pigmentation plaque that gradually disappears later. The purpura often recurs and is aggravated during the menstrual period. Patients generally have no internal organs and other parts of the bleeding. Mucosal bleeding is rare, sometimes a small amount of bleeding gums, increased menstrual flow, prolonged menstruation. The amount of bleeding during tooth extraction, surgery, trauma, and childbirth can be slightly more, but it will not cause severe bleeding.

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