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Forum Name: Hematology Topics

Question: Petechial Hemorrhage on inner thigh at knee, linear splinter


 Pale - Fri Jul 04, 2003 7:46 pm

Is there an answer for petechial hemorrgages on the inner thigh at knee and linear splinter hemorrhages on nails? After having a hysterectomy in 2002 I developed an infection in "the cuff" and was treated with IV antibiotics yet I still have had an infection there. I was just recently treated with Zithromax 1000mg once but I still am having crusty discharge showing pink. Anyone have any suggestions as to how I can have this infection treated sucessfully? :shock:
 Dr. Tamer Fouad - Sun Jan 29, 2006 7:42 am

User avatar Hello,

Have you been evaluated by a hematologist?

Hemostasis is usually broken down into two stages: primary and secondary. Primary hemostasis is an immediate (minutes) but unstable response to injury. The key participants are platelets (which form the platelet plug) and the blood vessels (which cause vasoconstriction). Secondary hemostasis, in contrast is a slower process (may take several hours) but results in a definitive fibrin clot (coagulation) that serves as the scaffold for vascular repair by the endothelium.

In the process of platelet plug formation, platelets adhere to exposed matrix molecules of the basement membrane both directly and indirectly through a bridging molecule, von Willebrand's factor (vWF).

In disorders of platelet plug formation (primary hemostasis) the site of bleeding is usually superficial such as in the skin, mucous membranes (gingivae, nares, genitourinary tract). Petechiae are present and ecchymoses is usually small, superficial. Hemarthroses, muscle hematomas are rare in such cases. However, bleeding after minor cuts is more common than those with defective coagulation. Bleeding after surgery is usually immediate and mild in those with primary hemostasis abnormalities.

Lab tests used to evaluate primary hemostasis include a complete blood count (CBC) with platelet count. Bleeding time when prolonged in the presence of a normal platelet count and the absence of aspirin (or other NSAID) intake may suggest a platelet function abnormality or a von Willebrand's factor (vWF) deficiency.

Henoch-Schonlein, or anaphylactoid, purpura is a distinct, self-limited type of vasculitis that occurs in children and young adults. Patients develop a purpuric or urticarial rash on the extensor surfaces of the arms and legs and on the buttocks as well as polyarthralgias or arthritis, colicky abdominal pain, and hematuria from focal glomerulonephritis. Despite the hemorrhagic features, all coagulation tests are normal.

Another type of vascular defect known to cause defective hemostasis is a result of acute infections, especially viral. Usually that resolves after the infection is over. Antibiotics such as sulfonamides are also known to cause purpura. In these cases thrombocytopenia is usually present.

Please see a hematologist and get a full evaluation.

Best regards.

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