Wednesday, October 5, 2011

Petechiae

This is what petechiae looks like:

update 2014: Petechiae from crying
Notice the bright red "freckling" around her eyes and across her cheeks.  These are "popped" blood vessels (capillaries) that occurred when Ellie was screaming during an ENT visit. 

update 2014: petechiae from screaming









Note the little freckling of red dots under her eyes and across her cheek bones. [Oct. 2011]


What exactly is petechiae and how does little Miss Ellie Bellie Bear come to have petechiae on her precious wee little face?

Definition: petechiae appears as small, red/purple/brown, pin-point dots  on the skin as a result of bleeding (from capillaries) under the skin's surface.  To differentiate between a rash and petechiae, the rash disappears when pressed on while petechiae remains.

Those tiny, needle-point, red-purple dots are petechiae.  This is Ellie's inner arm .






The How It Happened: screaming like a poor little terrified banshee while being held on her back, sans diaper for a urinary catheterization about 1 month ago.  My baby!  Mama bear was crying too but not enough to get petechiae.


Why are so many of us in the Down syndrome community freaked out by rashes that could possibly be petechiae?

One word: CANCER or make that two LEUKEMIA and cancer

Children with Down syndrome are at a greater risk for leukemia--as in 20 times higher than the general 46-chromosomed population . Those who carry that extra 21st chromosome are at a greater risk for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) with most cases of AML developing before the age of 5.  It is why our children must have routine CBC (complete blood count) labs drawn at well-child visits.

Sometimes, petechiae is sign of leukemia in our children because it suggests poor clotting.  The capillaries burst and leak into the surround skin, thus causing those pin-point dots.   Poor clotting can be the result of impaired platelet function (a component of our blood that works in clotting).  The nasty abnormal cancer cells start to crowd out the normal blood cells which include platelets.

Decreased platelets =  decreased clotting function  = bleeding under skin = petechiae

DO NOT PANIC!

Petechiae can be the result of so many things--not just cancer.  See Toddler Bear above--screaming popped some of those delicate little capillaries around her eyes.  Forceful vomiting can do the same thing.


Other causes of petechiae:

  • Forceful coughing 
  • Vomiting
  • Screaming (ie Ellie getting cathed)
  • Medications
  • Infections such as Mononucleosis, Measles, and enterovirus
  • Platelet Disorders
  • Vitamin K deficiency (infants)
Mechanical Trauma:

This is from a tourniquet used in Ellie's most recent blood draw.




This is the result of a little fall at a playground where she bonked the side of her forehead aka temple.





Viruses such as enterovirus (which by the way also causes low, intermittent fevers that also freak out the hypochondriac mama inside of me):




Now, I am the paranoid mama bear who sits quaking in my flip-flops due to Ellie's propensity to sprout petechiae at any given moment.  Routine CBCs have been normal.  I am slowly starting to calm down and not jump to conclusions every time Ellie Bear gets a patch of petechiae on her face, under hear arms, or on her ear lobes of all places.  My daughter is fair-skinned and some of her little capillaries are visible to the naked eye on her cheeks and neck.  Our pediatrician and myself believe that Ellie is just going to be a petechiael kind of girl.  Will we continue to monitor her blood cells?  Absolutely!  Will I panic with each episode?  No.  . . . well, in theory no.  


Photobucket
References:
The Mayo Clinic. Petechiae
National Cancer Institute.  Childhood Acute Lymphoblastic Leukemia.
Cinicnnati Children's Hospital Heart-Related Syndromes: Down Syndrome (T21)

24 comments:

  1. Thank you for sharing! This happens to Ben every time he screams after immunizations. I didn't know its name until this post. You've made me smarter:)

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  2. Okay, that was super-informative! I didn't actually know any of that. I've heard people talk about it, but Sammi doesn't really get them. Great information for people!

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  3. You are such a good momma. Thanks for the info on the petechiae.

    You overwhelm me with your energy and knowledge. It is a totally good overwhelming. I just couldn't keep up with you :-)

    You know so much and do so much to be sure Ellie is getting the best of the best and that you know everything you need to know.

    Like I said, what a good momma!

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  4. again thankyou for this post. are they raised at all or smooth? i ask because tilly gets similar on her arms but they are raised. xxx

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  5. Um, yeah. I freak the flip out every.single.time. And Elise gets them all the time. ALL THE TIME!!! As she is a cancer survivor and it was our first indicator, I allow my self the the flippy moments...however, she has been perfectly healthy on a CBC level for 8 years and she still gets them all the time...crying, slipping, coughing, rubbing clothes, falling, and vomitting...I think it's also aggravated by being SUPER fair...my other kids aren't that fair, and I don't see it nearly as often...

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  6. A little girl in our church has ITP and petechiae was the first sign..fortunately it was just episodic rather than chronic. One of my kids developed it after a screaming fit :P

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  7. Jane-good questions. They are actually smooth. The blood is beneath the surface. Tilly's might be keratosis pillaris. It is common among people with fair skin and occurs on the arms. . . I am warning you that I might have spelled that wrong!

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  8. Elissa--you give me too much credit! I have two nursing degrees and one is primary care pediatrics. That is why I know all that I do and why I FREAK all. the. time. Just remember that Google is NOT your friend. It is a scary, freak-out-causing nemesis. That's just my opinion :)

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  9. Tiffany--Yep, I freak all the time so I can only imagine how much you freak out given Elise's cancer history. My PCP thinks I am nuts because every time Ellie get's petechiae (even with a reasonable explanation such as screaming) I want a CBC. I wish I could do my own, at home CBCs!

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  10. This is so reassuring to read! Bailey has petechiae all of the time...literally, at all times there are some on one part of her body or another. We've had extensive blood testing done repeatedly and thankfully nothing was ever wrong with her blood. We freaked out when it first happened bc our older son had ITP when he was a baby, and of course, we've read the statistics about cancer. B's pediatrician and hematologist were both unsure as to why she's getting them so often, so it's great to read about others with the same experiences!

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  11. My Sophia had it on her legs at the same time as having a reaction to the MMR vaccine ... so the Measles rash combined with random petechiae caused some alarm and immediate CBC levels to be tested. Thankfully all was fine.

    My friend just lost her little boy to AML Leukemia, and now has to have her littlest with DS routinely tested since his chances of getting AML are now even higher with it being genetic as well as high likeliness in the downs community. I will let her know to watch for the signs of petechiae.

    And on another random side note, I get it on my ear lobes too if by chances my ear lobes got crushed in a wonky direction in my sleep.

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  12. This used to happen to Alex all the time when he was little. He seems to have out grown this (and the majority of the soul sucking tantrums).

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  13. Wow, this is exactly what my daughter has been having happen the last month and a half, I was scared because I know it is associated with Leukemia, but her CBC was pretty normal, a couple of things a little off but not alarming according to her doc. She has been getting it from band aids, or when she removed a stick on glitter decoration from her cheek the other day she got a big area of petichea...some of it around her shoulder blade and neckline looks like it may come from her sundress straps or carseat. I think its strange that she just started getting it, but I am praying that I will trust God and relax and nor worry constantly. I am hoping that maybe it is just because she is soooo fair skin and sensitive skin. Thanks for the info!

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  14. PeyKen1217, I understand how worried you are. I was panicked when Ellie started having petechiae. It is hard not to panic when you read everything out there. Ellie's labs have been normal and the episodes of petechiae come and go. She will not have any for a while and then she will have several episodes from random things such as sleeping funny, a shoe strap, etc. I pray that your daughter is okay and that it is just a random occurrence.

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  15. Hello, thanks for posting your story. My son has had Petechiae for about 3 weeks now (that we know of)mainly on his upper arms and shoulders and occasionally on his chest. He has a spot every once in a while on his leg or cheek but not much. He went for a blood test last Wednesday (over a week ago) and it all came back great (doc said white blood cells were slightly high but very common with a little virus). We can't stop worrying every time he gets a new spot but if he truely had leukemia wouldn't it show in the blasts and wouldn't his platelets be low? I think the thing that is hard is reading stories on the internet and everyone screams cancer/leukemia. How is your daughter doing? My so in VERY pale skinned by nature (blue eyes, blondish hair)and he eats like a horse and is hardly ever sick and he is in daycare. Should we still be worried (I think we will be anyway until it goes away or we find a fix, God Willing)? Thanks for your time.
    Jeff

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    1. Hi Jeff! I apologize for writing this so late. just now seeing your comment. Petechiae is often related to low platelet counts. There are a few forms of leukemia and some are related to the neutrophils--thinking of those blasts and then about the petechiae. My daughter, as you can see is pale, and seems very prone to petechiae. I have no idea why but she will go for a while without them and then suddenly have there where her pulled up is or her carseat straps are. Her blood always looks perfect. As with any medical questions, it is best to talk to your son's doctor. You know your child better than anyone, but a pedi can also help figure out if & what is going on.

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  16. How is the petechia going? Please email me at ma_cabbage_patch@yahoo.com. My son developed petechia at 10 months old and had a lowish fever for four days. The doctors were going to just send us back home until I mentioned him develop freckles. He had a bottomed out WBC count and he was extremely neutropenic. He was in the hospital in isolation for almost a week before he was finally discharged. The hospital checked his blood cells for leukemia and they also sent it out to get a second opinion. They also could not figure out why his immune system bottomed out so badly. We have seen a few different blood specialist and they keep running platelet function tests and they have all come back normal. However, He is almost two years old and he still gets petechia pretty severely. I am trying not to worry to much because he "seems" normal. However, it just doesn't seem "normal" for him to still be getting petechia. So, I was wondering if it has gone away or if it is still an issue.

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  17. I should add that the tests came back negative for leukemia.

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    1. That is a HUGE relief! Petechiae can be benign, but cancer also tends to lurk in the back of my mind.

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  18. Thank you!!! I have been looking ALL OVER for any indication of what this condition is (my 2YO son gets it regularly, and always after a bout of screaming), to no avail. Thank you for sharing your information.

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  19. I started noticing petechiae on my five year old son back in July. He is also pretty fair. He gets them on his back, stomach, sometimes face and neck. Occasionally I will see them on his legs. We have had three or four blood tests and everything has come back normal. No sign of anything. Every time I go to my pediatrician they kind of act like I am either making it up, or they don't know what to think. Our next step is a hematologist, I'm wondering, is it worth it to even go? I know it is it just seems like there is no answer. Maybe it is just the way some kids bruise. Especially healthy kids. It's terrrifying to read things about it though. I wonder if he will grow out of it or always have it? When we visited the emergency room because I was so worried at first, the doctor told me if you have small veins or arteries, they are more prone to breaking easily. I think they were thinking it was caused by some virus he had had. But now it has lasted this long, I am not so sure. Thanks for posting this. brought me back down from my freak out session :)

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  20. Thank you for this blog post I think your May have just allowed me to breath again. I'm say in a hospital room at the mo waiting for blood test results. He is 3 months old and just got his third case of petichae. I'm sat here telling myself not to worry and the little voice in my head is whispering leukaemia. The Drs haven't even mentioned it they are just 'checking his blood for abnormalities' but being a nurse I know why. Ok must remember to breath I am 90% sure it's due to pressure and he is just prone I agave super sensitive skin and contact dermatitis and air he is the same x

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    1. Gem, how scary! I am so happy that you went to the ER. How is your baby? Please tell me that he just has very sensitive skin. It is so hard not worry. . . esp when you are in the medical field!

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