Differentials

Differentials

Vascular disorders:

• Senile purpura: Common & benign, capillary fragility in elderly, bilateral brown discolouration on extensor surfaces, usually disappears after a few months
• Simple purpura (aka easing bruising) is common in females aged 20-30 years on arms & legs after minor trauma
• HHT (aka Osler-weber-rendu syndrome): Autosomal Dominant, telangiectasia on mucous membranes, organs, skin
• Ehlers-Danlos: hypermobility with easy bruising
• Osteogenesis imperfecta: Autosomal Dominant, blue sclera, short stature, adult hearing loss, bone fragility & easy bruising – Vitamin C deficiency (scurvy)

Platelet disorders: Seen after trauma

• ITP: post-viral, self-limiting within 6 months, usually in children
• HSP: non-blanching rash (buttocks, legs, back), joint pain, GI symptoms, proteinuria, following a URTI in kids
• Aplastic anaemia: pancytopenia (fatigue, pallor & increased infection risk)
• Malignancies w/ Bone marrow involvement: leukaemia, neuroblastoma, myeloma – Liver disease
• ESRD (disrupts platelet aggregations & prolongs bleeding time)

Coagulation disorders: Delayed response after trauma

• Von Willebrand disease: factor VIII deficiency, increased APTT, Autosomal dominant, usually mild.
• Vitamin K deficiency affects factors 2,7,9,10, protein C and S, and increased PT and APTT. It can cause haemorrhagic disease in newborns. Risk factors include exclusively breastfeeding, no vitamin K dose given after birth, and secondary malabsorption when older. – Haemophilia A/B: X-linked recessive, factors VIII(A)/IX(B) deficiency. Increased APTT. It is most severe in males; rarely are female carriers symptomatic (unless consanguinity/Turner syndrome). Associated with Hemarthrosis
• Liver disease: Impaired synthesis of clotting factors
• Amyloidosis