Hemorrhagic purpura found in adults and children is an inflammatory disease that affects capillaries. The same disease is known as vasculitis. It is called Shenlein-Genoch disease. Most often, the foci are located in the capillaries of the skin, kidneys, intestinal tract.
Due to the inflammatory process, bleeding is observed. Areas of hemorrhage on the skin are noticeable due to purple, red rashes. If bleeding is localized in the tissues of the intestinal tract, kidneys, then urine and stool contain inclusions of blood.
Relevance of the issue
The code for hemorrhagic vasculitis according to ICD 10 is D 69.0. Under this code is a disease that is relatively common in children aged 5-12 years. It has been established that boys suffer from such purpura approximately twice as often as girls. Ethnicity does not affect the risk of developing a pathological condition. No dependence on geography, human habitat was revealed. In the northern powers, on European lands, doctors with such a disease are often consulted in the winter, although there is a chance of getting sick in the summer season, and in spring, in autumn. On average, the frequency of visits per year is two dozen patients per hundred thousand minors.
Where did the trouble come from?
Designating hemorrhagic vasculitis in ICD 10, code D69.0 hides under itself a disease that is provoked by causes not yet known to scientists. It is believed that the infectious pathogen may be the root cause of the process. Certain risks are likely to be associated with both bacteria and viruses. Under their influence, certain pathological processes begin in the body, sooner or later ending with vasculitis. This assumption was made by analyzing many cases recorded in science: they were formed in individuals who underwent inflammatory processes in the respiratory system.
There are known cases of the appearance of a disease after a bite, while taking medication. If a person is chilled too much, he was exposed to the aggressive influence of chemical compounds, if allergens got into his body with food, there is also a risk of developing purpura. In some cases, the disease is a response to infection, reflecting the excessive aggressiveness of the immune system.
Reasons and Genetics
It is believed that in children, in adults, hemorrhagic purpura indicates an inadequate immune response. The sites in which the disease develops, studies have shown, are an area of ​​accumulation of the unique substances generated by the immune system. First of all, it is immunoglobulin A. As a result, small vessels are damaged, which are very numerous in the skin, articular region, gastrointestinal tract, and kidneys. Damage to the central nervous system. Testicles may be affected.
The disease does not belong to the inherited class. It is not infectious. At the moment, there are no reliable specific preventive measures for this type of purpura.
How to notice?
If the causes of hemorrhagic purpura are not yet clear to science, then the symptoms are recorded in specialized reference books. A key manifestation of the disease is a specific type of skin rash that is characteristic of all patients. More often, the start of the process is small urticaria. Reddish zones appear, protruding above the general level of the skin. Over time, the color transforms purple, indicating a hemorrhage. The condition is called palpable purpura, since the rash can be easily felt. More often the phenomenon affects the buttocks, legs. Less commonly observed affected areas of the hands, areas on the body.
Symptom of hemorrhagic purpura may be pain in the articular zones, swelling of the joints, limiting the ability to move these zones. This often bothers the ankle, knees, less often the wrists, elbows, and fingers of the upper extremities. Symptoms of such a plan are observed in more than 65% of patients. Arthritis, arthralgia are accompanied by mild swelling, pain in the soft tissues nearby. At an early stage, especially in a young child, arms and legs, genitals, forehead can swell. Joint symptoms are usually temporary, some disappear in just a few days, others - after a month or a few.
Symptoms: inflammation and pain
It is possible to assume Shenlein-Genokh purpura on vascular inflammation. Such a symptom is observed in 60% and more often, almost always goes in combination with abdominal pain. The nature of the sensations is intermittent, the area of ​​localization is the navel. Hemorrhage is possible. Occasionally, an inversion of intestinal loops, obstruction of the tract, blockage is recorded. An urgent operation may be needed to help the patient.
If the renal vessels become inflamed, bleeding bothers every fourth, according to other estimates - every third patient. The inclusion of blood elements in urine is possible, and analyzes can show the presence of proteins in the liquid. Degree - from mild to severe very strongly. Renal disorders are usually mild, occasionally the disease lasts for months, years, progresses. On average, with a probability of no more than 5%, renal failure is possible. In each individual case, it is recommended to check the patient's condition with a nephrologist.
Symptoms: subtleties
A key manifestation of purpura is skin rashes. All other symptoms may appear before the formation of areas of rashes. Perhaps the simultaneous appearance of all manifestations, a gradual deterioration. It is extremely rare that the disease is accompanied by cerebral hemorrhage, pulmonary edema, testicular edema. This is due to inflammatory processes in the vascular zones. In practice, such a course is observed in a small percentage of cases.
How to clarify?
Diagnosis of hemorrhagic purpura begins with a clarification of the clinical picture. The doctor evaluates the rash, most often observed only on the legs, buttocks. Most have at least one of the additional manifestations - pain in the joints, abdomen, kidney damage. Diagnostic measures require differentiation of the diagnosis from similar diseases. A skin biopsy can determine the presence of immunoglobulin A. Such an event is prescribed relatively rarely.
There are no specialized studies aimed at the diagnosis of Shenlein-Genoch purpura. ESR, the concentration of C-reactive protein in this disease is either normal or slightly above normal. If there is hidden blood in the feces, this may indicate purpura, a small bleeding in the intestinal tract.
To determine whether the kidneys are affected, it is necessary to check the quality of urine. Weak hematuria is a common symptom of pathology, which eventually exhausts itself. In some cases, a kidney biopsy is needed. This event is carried out if the organ damage is significant, pronounced proteinuria is observed, or studies show the failure of the functioning of the organ.
Diagnostics: nuances
Sometimes a study is shown by visualizing internal organs. The classic option is ultrasound. It is indicated to rule out other causes of abdominal pain. Ultrasound is needed in order to detect complications in time. In particular, it is used for suspected intestinal obstruction.
Treatment
Treatment for hemorrhagic purpura is not always necessary. The main percentage of patients easily tolerate the disease. Recommended bed rest. In some cases, the doctor prescribes drugs - mainly with the aim of maintaining the condition. To reduce soreness, they resort to classical analgesics. Most often prescribed "Paracetamol." If the pain is severe enough, non-hormonal anti-inflammatory drugs may be needed. This is often necessary if you are concerned about sore joints. Use "Naproxen" or drugs containing ibuprofen.
In some cases, the use of hormonal anti-inflammatory drugs is necessary. Most often they are prescribed orally, sometimes for administration into a vein. Such treatment is needed if a person suffers from severe disabilities in the stomach, intestines, and bleeding. Hormonal drugs are used for severe manifestations of purpura and lesions of various internal organs. If the disease is severe, a renal biopsy and subsequent combination treatment are recommended. Anti-immunity drugs and hormonal anti-inflammatory drugs are prescribed.
The nuances of therapy: a fly in the ointment
Although hemorrhagic purpura is treated with a wide variety of pharmaceutical products on the market, this does not mean that you can choose some medication that works perfectly without creating additional risks. All medicines available to modern patients can cause side effects.
Most often, in the case of purpura, medication is not necessary or medications are prescribed shortly. Such therapy is associated with a minimum of risks. If severe renal damage is detected, if the patient is shown medications containing prednisone, side effects may occur. The longer the treatment lasts, the higher the likelihood of undesirable consequences. The specific set of adverse reactions is determined by the drug product prescribed for the patient.
About Duration
On average, the acute stage of hemorrhagic purpura lasts from a month to a half. Approximately half of patients have at least one exacerbation in six weeks, while it is easier than the first case. Relapses are rarely observed in a later period. The fact of relapse does not indicate the severity of the disease. The outlook is positive. Most recover completely.
Therapy: an integrated approach
Some publications recommend a comprehensive treatment of purpura. It is necessary to review the diet, excluding products that can provoke allergies. In addition, bed rest and medications are indicated if necessary.
You can prescribe disaggregants to the patient. The classic version is Curantil in an amount of 2-4 mg per kg of body weight per day. You can enter “Trental” veins in drops, apply “Indomethacin”. Dose - 2-4 mg per kg of body weight.
Recommended heparin. For every kg of weight you should get 200-700 units. The drug is injected into a vein or under the skin. Frequency - four times daily. The dose is gradually reduced. In severe cases, plasmapheresis is indicated. A good effect is the inclusion of nicotinic acid in the course.
Reliable drugs: Colchicum Dispersion
Sometimes colchicine is prescribed for treatment. Instructions for the preparation “Colchicum Dispersion” indicate the content in each tablet of 500 μg of this substance in the form of alkaloids obtained from the extract of dried colchicum seeds. The drug belongs to the number of effective not only with purpura, but also with gout. Under his influence, white blood cells move more slowly to the area of ​​inflammation. An antimitotic effect has been revealed; the generation of cute fibrils becomes slower. The tool is directed against neutrophilic degranulation.
As can be seen from the instructions, colchicine contained in the preparation "Colchicum-Dispersion", not only shows a positive effect in purple, but also eliminates the exacerbation of Mediterranean fever. Under its influence, the life expectancy of those suffering from primary AL amyloidosis increases. In the case of scleroderma, which developed in a systemic form, the drug improves the condition of the skin.
About doses
Used in the fight against hemorrhagic purpura, Colchicum Dispersion is intended for oral administration. It is necessary to swallow the tablet completely. No need to chew, break or bite. It is necessary to drink plenty of medicinal product with clean water without additives. The recommended dose is 0.5-0.6 mg of the drug twice a day.
Used in the fight against hemorrhagic purpura "Colchicum-Dispersion" can cause hair loss, anemia. There are known cases of the development of agranulocytosis, neuropathy. Occasionally, leukopenia was recorded. It is known that some had disturbed stools, and abdominal pain disturbed them.
Is it possible or not?
"Colchicum-Dispert" is prohibited for pregnant women. He is not prescribed to nursing mothers. The drug is not used for poor liver and kidney function. Contraindication is hypersensitivity to any component of the drug. You can not prescribe "Colchicum-Dispersion" if the hematopoietic function of the spinal cord is greatly inhibited.
Persons of advanced age and against the background of cachexia, “Colchicum Dispert” is prescribed with caution. It is necessary to carefully monitor the condition of patients in whom the work of the heart, blood vessels, and gastrointestinal tract is severely impaired.