Physical Exam

Which of the following physical findings might be seen in a patient with severe thrombocytopenia?

a
Petechiae
Correct. Petechiae are defined on the next slide.
b
Glossitis
Not associated with thrombocytopenia.
c
Splenomegaly
This might be found in hypersplenism (a cause of thrombocytopenia) or in cases of secondary ITP, for example in patients with ITP associated with chronic lymphocytic leukemia or lymphoma.
d
Ecchymoses
Correct. Ecchymoses are defined on the next slide.

True or false: A bruise is synonymous with an ecchymosis.

a
True
b
False

Referring to patients with thrombocytopenia, the 2019 American Society of Hematology Self-Assessment Program (7th Edition) states:

“Dependent areas and skin underneath tight clothing should be examined for petechiae and purpura, and oral mucous membranes should be examined for hemorrhagic bullae, which may be associated with an increased risk of severe bleeding at other sites.”

The following describes this patient’s physical exam when you see him:

Vital signs: Heart rate is 75/min, blood pressure 145/88

Head and neck: Purpuric lesions on roof of mouth and blood blisters on oral mucosa; no lymphadenopathy

Chest: Normal to inspection, palpation, percussion, and auscultation

Abdomen: Non-tender, no hepatosplenomegaly

CNS: Grossly normal

Skin: Petechiae on lower limbs

Petechiae on lower extremity. From Shutterstock, with permission.
Bruising (ecchymoses) on arm. From Shutterstock, with permission.