Vascular Bleeding (Petechia; Purpura)
Any condition in which blood leaks out of the vessels that normally contain it constitutes vascular bleeding. If the leaking blood invades skin tissue, it shows up as bruises, ranging from tiny reddish-brown or purple dots, called petechiae, to larger patches, referred to as purpura.
Of the various types of vascular bleeding, two of the most common are purpura simplex, a condition marked by easy bruising, and senile purpura, which occurs among older people. Easy bruising appears to run in families, and is often seen in women of childbearing age who develop discolored patches on their upper arms, thighs, and buttocks without sustaining any injury. In the past, these patches were sometimes referred to as devil's pinches and interpreted as a sign of witchcraft. They may develop during the night or immediately before a menstrual period. As a rule, they are not painful and vanish as unaccountably as they appeared.
Senile purpura takes the form of irregular, deep purple splotches that appear on the forearms and hands of older people. These patches usually disappear within a week or two, but sometimes they last for months or even years, often evolving into permanent brown areas on the skin.
Allergic purpura, also called anaphylactoid purpura, shows up as a skin rash that appears suddenly, most commonly on the arms, legs, buttock, and feet. Although it occasionally occurs in adults, more frequently it affects children, often following an infection such as strep throat. It might also be a reaction to a drug, during which the body's immune response causes an inflammation that weakens the vessel walls. The bleeding may be accompanied by fever, kidney damage, and joint pain and swelling, especially of the knees, hips, wrists, and elbows.
Another childhood bleeding disorder is called acute idiopathic thrombocytopenic purpura (ITP). It typically follows a viral infection that has reduced the number of platelets, which are blood cells instrumental in clotting. Chronic ITP, which occurs mostly in women aged 20 to 40, is an autoimmune disorder that causes accelerated destruction of platelets.
Most types of vascular bleeding are the result of a temporary change in blood composition (especially the condition or supply of platelets) or the deterioration of the tissue making up the blood vessel walls, causing them to rupture easily. This deterioration is presumed to be the underlying cause of senile purpura, which may also be triggered by excessive exposure to the sun.
Other possible causes of purpura include rare hereditary disorders of connective tissue and autoimmune diseases that reduce the level of platelets in the blood. Rocky Mountain spotted fever can also cause a type of purpura.
Diagnostic Studies and Procedures
Vascular bleeding can easily be detected by examining the skin, but finding the underlying cause generally requires blood studies to determine the platelet count and dotting function.
Easy bruising is not serious and no drug can prevent its occurrence. Individuals who are afflicted with this condition may be advised to avoid aspirin and other medications containing salicylates, although no compelling evidence has shown that these drugs contribute to this type of bleeding. Similarly, there is no treatment for senile purpura.
If a particular drug appears to trigger allergic purpura, an alternative medication should be sought. When the kidneys are involved, steroids may be given, but caution is needed because these drugs themselves can also cause easy bruising.
ITP is usually treated with steroids and sometimes removal of the spleen. Researchers are hopeful that the hormone thrombopoietin, which speeds up the production and regrowth of blood platelets, may prove to be an effective treatment for ITP and other types of vascular bleeding.
Naturopaths and nutrition therapists often advocate high doses of vitamin C for vascular bleeding. Although this vitamin is essential to maintain the walls of blood vessels, there is no evidence that vascular bleeding is a deficiency disease. A well-balanced diet that provides ample citrus fruits and other fresh fruits and vegetables should supply all the vitamin C that the body needs.
Aside from avoiding drugs or other substances that provoke allergic purpura, there is not much you can do to self-treat vascular bleeding. If you have thin skin and tend to bruise easily, minimize your time in the sun. Unsightly bruises that appear on the arms and legs can be covered with an opaque cosmetic.
Other Causes of Vascular Bleeding
Scurvy, a rare disease caused by severe vitamin C deficiency, can result in bruising and bleeding gums. Other possible causes of vascular bleeding include leukemia, hemophilia, and clotting disorders. Heavy alcohol consumption and frequent use of aspirin can also cause bleeding.