Ecchymosis

Introduction Ecchymos, medical terminology, subcutaneous or submucosal plaque hemorrhage caused by increased vascular permeability due to various factors such as injury, poisoning, infection, allergies or thrombocytopenia. It refers to red or purple blood spots with a skin surface diameter of 10 mm (mm) or more.

Cause

(1) Extravascular factors. If the surrounding tissue of the blood vessels is weakened 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. It 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 factor. 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 (also known as symptomatic purpura, which can be caused by thrombocytopenia caused by bone marrow hematopoietic disorders, caused by aplastic anemia, leukemia, and cancerous bone metastasis), radioactive substances, and chemicals that destroy megakaryocytes. Reduced platelet production, severe infections (such as typhoid fever, meningitis, sepsis), excessive platelet destruction. In addition, hypersplenism, lupus erythematosus, uremia, etc. can also reduce thrombocytopenia. There are differences in platelet function-deficient diseases. 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) Factor of clotting factor. The lack of coagulation factors 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

Physical examination of skin diseases

1. Vascular purpura. Very common, due to vascular wall damage or increased fragility and permeability, common in immune (such as allergic purpura), infectious (such as sepsis), abnormal vascular structure and other (such as abnormal proteinemia) , simple or senile purpura, etc.) diseases. Check that there is no abnormality other than the beam arm test may be positive.

2. Platelet abnormal purpura. Most common, mostly due to thrombocytopenia, increased and dysfunction, if the buccal mucosa of the oral cavity has purpura or blood blister, often indicates severe bleeding, should be actively treated.

3. Coagulation mechanism disorders, including clotting factor deficiency, anticoagulant substances in the circulation or hyperfibrinolysis, generally caused by bleeding caused by coagulation mechanism disorders, mainly manifested as joint blood, muscle hematoma and visceral hemorrhage, less skin Purpura, only when it appears as a large ecchymosis, and check the coagulation has obvious abnormalities, which can be differentiated from purpura caused by vascular purpura and platelet abnormalities. The treatment of purpura varies according to the cause.

Differential diagnosis

Symptoms of ecchymosis:

Freckles should be distinguished from each other. Freckle, red or purple blood spots with a skin surface diameter of 10 mm (mm) or more. Defective, red or purple blood spots below 2 mm (mm).

A red or purple blood spot with a diameter of 10 mm (mm) or more on the surface of the skin can be diagnosed. And the possibility of skin allergies, injuries, eczema and other reasons.

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