Makindo Medical Notes

🧠 Introduction

Petechiae are non-blanching, pinpoint haemorrhages caused by rupture of small dermal blood vessels. They are never normal in children and always warrant careful assessment. 🔴 Pathophysiology: Can result from platelet abnormalities (low number or dysfunction), coagulation defects, vascular fragility, or infection-induced endothelial damage. ⚠️ In children, meningococcal sepsis must always be excluded urgently.

🩺 Initial Assessment

1. History:
   • ⏱️ Onset & duration – acute vs chronic rash.
   • 🤒 Associated symptoms: fever, malaise, joint pain, abdominal pain, bleeding elsewhere.
   • 🧬 Medical/family history: bleeding disorders, autoimmune disease.
   • 💊 Medications: NSAIDs, aspirin, antibiotics, anticoagulants.
   • 🥗 Diet & lifestyle: vitamin C deficiency, recent trauma, exertion.
2. Examination:
   • 👀 General: pallor, jaundice, irritability, systemic illness.
   • 🌡️ Vitals: fever, tachycardia, hypotension (shock).
   • 🖐️ Skin: distribution, blanching vs non-blanching, bruises/ecchymoses.
   • 🩸 Abdominal: hepatosplenomegaly (malignancy, infection, portal HTN).
   • 🦵 Joints: swelling, tenderness (vasculitis, HSP).
   • ENT: pharyngitis, lymphadenopathy, tonsillar exudate.

🔬 Investigations

• 🧪 Bloods: CBC (platelets, Hb, WCC), coagulation profile, CRP/ESR, LFTs, U&E.
• 🦠 Microbiology: Blood cultures if sepsis, throat swab if streptococcal infection, viral serology (EBV, CMV).
• 🦴 Bone marrow aspiration: if unexplained cytopenias or suspected leukaemia/aplastic anaemia.
• 🥗 Other: Vitamin levels (C, B12, folate), autoimmune screen (ANA, ANCA).

🚑 Management Principles

1. Immediate Stabilisation:
   • 💉 ABC approach (airway, breathing, circulation).
   • ⚡ Broad-spectrum antibiotics if meningococcal sepsis suspected (do not delay).
   • Oxygen, IV fluids if shocked.
2. Treat Underlying Cause:
   • 🦠 Infections → antibiotics/antivirals as indicated.
   • 🩸 ITP → IVIG or steroids if severe bleeding.
   • 🧬 Autoimmune vasculitis → steroids/immunosuppressants.
   • 🔄 Nutritional → vitamin replacement (e.g. vitamin C for scurvy).
3. Supportive Care: Analgesia, antipyretics, transfusions if required.
4. Referral: Early haematology / infectious disease / rheumatology involvement.

💡 Red Flag: Petechial or purpuric rash with fever and shock = meningococcal sepsis until proven otherwise ➝ urgent antibiotics & resuscitation.

📊 Causes of Petechial Rash – Children vs Adults