Paediatric-History taking & Physical examination of Patient with Petechiae or Purpura

Paediatric-History taking & Physical examination of Patient with Petechiae or PurpuraCreated OnApril 28, 2020Last Updated OnApril 28, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of Patient with Petechiae or Purpura < All Topics Table of Contents History taking: Initial approach must rule of life-threatening meningococcal infection that requires immediate intervention Ask about identification of patient – Age, Sex Age of onset At birth: Intrauterine infection, maternal idiopathic thrombocytopenic purpura, maternal SLE, maternal medication, TAR syndrome, congenital amegakaryocytic thrombocytopenia At 2 to 4 years: Idiopathic thrombocytopenic purpura At 4 to 7 years: Henoch-Schönlein purpura Sex of patient Hemophilia is X-linked and only affects males Von Willebrand is autosomal dominant and is seen with equal frequency in boys and girls. Ask about onset and progression of rash Acute onset: Idiopathic thrombocytopenic purpura, Henoch-Schönlein purpura, medication, mechanical cause Chronic/recurrent purpura: Platelet disorders, inherited coagulopathy Fever – Important cause of purpura in children is infection. Type of bleeding manifestation distributions, colour and size Petechiae – common in thrombocytopenia and platelet disorders Mucosal bleeding (menorrhagia, epistaxis) – common in platelet disorders and von Willebrand disease Bleeding into the joints (hemarthroses) – common in patients with hemophilia. Distribution: Rash at gravity dependent areas (buttocks, lower limbs) – Henoch-Schönlein purpura Colour and size: Bruises in different stages of healing and different sizes may be suggestive of child abuse Ask about associated features Fever, irritability, lethargy, stiff neck, photophobia, altered consciousness, seizures (Meningococcal) Abdominal pain, hematuria, joint pain (Henoch-Schönlein purpura, HSP) Persistent lethargy, fever, infection, bone pain, weight loss, night sweat (Leukemia) Intermittent fever, musculoskeletal symptoms (Systemic lupus erythematosus) Lethargy, polyuria, polydipsia, failure to thrive (Uremia) Purpura with preceding infection but otherwise healthy (Idiopathic Thrombocytopenic Purpura, ITP) Ask about prior bleeding history Ask about past medical history Antecedent viral infection (HSP, ITP) Liver disease (coagulopathy), renal disease (uremia) Ask about family history of bleeding Ask for any purpura or bleeding disorders running in family. A positive family history in male relatives on the maternal side suggests factor VIII or factor IX deficiency. von Willebrand’s disease is a condition that affects both sexes due to dominant inheritance Wiskott-Adrich syndrome Ask about drug history – ask about exposure to aspirin, warfarin, alkylating agents or antimetabolites that may affects the platelet. Ask about nutrition...

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