From the Guidelines
Petechiae are small, pinpoint-sized red or purple spots that appear on the skin due to bleeding underneath the skin's surface, and according to the American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia 1, they can be a manifestation of mild bleeding in children with low platelet count. When considering the management of petechiae, it's essential to evaluate the overall clinical context, including the presence of other bleeding symptoms.
- Petechiae typically measure 1-2 millimeters in diameter and don't blanch (fade) when pressure is applied, which distinguishes them from other skin rashes.
- They commonly appear in clusters on areas like the legs, arms, chest, face, or inside the mouth.
- Petechiae can result from various causes including infections, blood disorders like thrombocytopenia, certain medications, vitamin deficiencies, or physical trauma. However, in the context of a child developing an episode of epistaxis (nosebleed) that lasts about 15 minutes, the decision to treat should be based on the bleeding, as indicated by the guideline 1.
- The guideline recommends that children with no bleeding or mild bleeding (defined as skin manifestations only, such as bruising and petechiae) be managed with observation alone regardless of platelet count.
- But, in cases where bleeding is more severe, such as epistaxis, treatment should be considered to prevent further complications. It's crucial to seek medical evaluation if petechiae develop without an obvious cause, especially when accompanied by other symptoms like unexplained bruising, bleeding gums, or fatigue, to determine the underlying cause and appropriate treatment.
From the Research
Definition and Causes of Petechiae
- Petechiae are small hemorrhagic spots that can appear on the skin, often as a result of bleeding from small blood vessels [ 2 , 3 ].
- They can be caused by various factors, including mechanical reasons such as tourniquet phenomena [ 2 ], or as a result of underlying medical conditions such as thrombocytopenia [ 4 ] or coagulation disorders [ 5 ].
Clinical Presentation and Diagnosis
- Petechiae can present as isolated lesions or as part of a larger syndrome, and their diagnosis often requires a thorough medical evaluation [ 2 , 5 ].
- In some cases, petechiae can be a sign of more serious underlying conditions, such as traumatic asphyxia [ 6 ].
Associated Conditions and Symptoms
- Petechiae can be associated with other symptoms, such as easy bruising, bleeding, or swelling, and can be a sign of underlying conditions such as hemophilia or von Willebrand disease [ 5 ].
- In rare cases, petechiae can be a sign of non-accidental trauma, and medical providers should be aware of the clinical presentation of traumatic asphyxia [ 6 ].