Evaluating the Child with Purpura -- American Family Physician
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چکیده
www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 419 vessel wall and, in response to the exposed subendothelial collagen, release adenosine diphosphate (ADP) and thromboxane A2. The released ADP and thromboxane A2 cause further platelet aggregation and the formation of a platelet plug that is responsible for primary hemostasis. Secondary hemostatic mechanisms consist of a series of sequential enzymatic reactions involving various coagulation factors and leading to the formation of a fibrin clot. The intrinsic pathway is activated by the exposed collagen, and the extrinsic pathway is activated by tissue thromboplastin (Figure 1). The integrity of the vascular system depends on three interacting elements: platelets, plasma coagulation factors and blood vessels. All three elements are required for proper hemostasis, but the pattern of bleeding depends to some extent on the specific defect. In general, platelet disorders manifest petechiae, mucosal bleeding (wet purpura) or, rarely, central nervous system bleeding; coagulation disorders present as ecchymoses or hemarthrosis; and vasculitic disorders present with palpable purpura.
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