The vascular disorders , sometimes previously classified as non-thrombocytopenic purpuras, are characterized by easy bruising and bleeding into the skin. Bleeding from mucous membranes sometimes occurs but the bleeding is rarely severe. Laboratory investigations including the bleeding time are normal. The vascular disorders include the following.
HEREDITARY HAEMORRHAGIC TELANGIECTASIA.
This is a rare disorder with autosomal dominant inheritance. Dilatation of capillaries and small arterioles produces characteristic small red spots that blanch on pressure in the skin and mucous membranes, particularly the nose and gastrointestinal tract. Recurrent epistaxis and chronic gastrointestinal bleeding are the major problems and may cause chronic iron deficiency anaemia.
EASY BRUISING SYNDROME. This is a benign disorder occurring in otherwise healthy women. It is characterized by bruises on the arms, legs and trunk with minor trauma, possibly due to skin vessel fragility. It may give rise to the suspicion of a serious bleeding disorder.SENILE PURPURA AND PURPURA DUE TO STEROIDS.
These are both due to atrophy of the vascular supporting tissue.
PURPURA DUE TO INFECTIONS. This is mainly due to damage to the vascular endothelium.
HENOCH-SCHONLEIN PURPURA. This usually occurs in children. It is a type III hypersensitivity reaction that is often preceded by an acute upper respiratory tract infection. Purpura is mainly seen on the legs and buttocks. Abdominal pain, arthritis, haematuria and nephritis also occur. Recovery is usually spontaneous but some patients develop renal failure.
FACTITIAL PURPURA. Episodes of inexplicable bleeding or bruising may represent abuse, either self-inflicted or caused by others. These various forms of artificial or factitious purpuras are often expressions of severe emotional or psychiatric disturbances.