Side Effect: Bleeding into the Skin (petechiae, purpura, ecchymosis)

What is Bleeding into the Skin (petechiae, purpura, ecchymosis)?

Petechiae, purpura, and ecchymosis are all terms used to describe different types of bleeding into the skin. These symptoms occur when tiny blood vessels (capillaries) burst or have a small tear and allow red blood cells to leak out into the surrounding tissue.

What does Bleeding into the Skin (petechiae, purpura, ecchymosis) look like?

Petechiae, purpura, and ecchymosis appear as red or purple spots on the skin and do not blanch (become faint, or turn a lighter color like a rash may when touched) when pressure is applied.

• Petechiae are small, pinpoint spots less than 3 mm in diameter.
• Purpura is larger than petechiae and are between 3 and 10 mm in diameter.
• Ecchymosis is a large, flat area of bleeding under the skin measuring more than 10 mm in diameter and is the medical term for a bruise.

External bleeding does not happen with any of these types of minor blood loss unless the skin breaks open and releases the trapped red blood cells.

Who gets Bleeding into the Skin (petechiae, purpura, ecchymosis)?

• Petechiae and purpura can occur due to a variety of reasons, including infections, medications, autoimmune disorders, and bleeding disorders.
• In patients with cancer, petechiae, purpura, and ecchymosis can occur due chemotherapy, radiation therapy, and cancer itself.
• Petechiae and purpura are commonly seen in patients with thrombocytopenia, a condition characterized by low platelet count.

Older adults are also more prone to developing petechiae and purpura due to age-related changes in blood vessels making them more fragile. In addition, as we age, we lose collagen in our skin which helps to protect blood vessels and allows them to move more freely without breaking.

Ecchymosis, which is a slightly larger form of red blood leaking into skin, can be caused by trauma (such as bumping into something hard), or due to underlying medical conditions, such as bleeding disorders or liver disease.

How to prevent Bleeding into the Skin (petechiae, purpura, ecchymosis)

Preventing petechiae, purpura, and ecchymosis largely depends on addressing the underlying cause. For example, people with bleeding disorders may need to avoid certain medications or take medications to help control bleeding. Treating infections promptly and avoiding trauma or injury to the skin can also help prevent these conditions. Patients with low platelets may need to receive platelet transfusions to help prevent all types of bleeding, especially if the platelet count reaches very low levels (for example, platelets less than 10,000/µL).

How to treat Bleeding into the Skin (petechiae, purpura, ecchymosis)

Treatment of petechiae, purpura, and ecchymosis in patients with cancer depends on the underlying cause and severity of the condition.

• In patients with thrombocytopenia, platelet transfusions may be necessary to manage bleeding.
• Adjustments to the cancer treatment regimen may be needed if bleeding is due to chemotherapy or radiation.
• In patients with coagulopathy due to liver disease, correcting the underlying liver dysfunction may help to improve coagulation and prevent bleeding.
• In malnourished individuals, a vitamin K supplement may help the liver to make clotting factors to help stop bleeding
• In some cases, blood products like fresh frozen plasma and cryoprecipitate or certain medications like aminocaproic acid (Amicar®) or tranexamic acid (Lysteda®) may be used.
  • Importantly, Amicar® and Lysteda® must be used cautiously as the risk of forming an unwanted clot in patients who also have a condition known as “D.I.C.” (disseminated intravascular coagulation) may outweigh any benefits.