Small petechiae on the skin can occur due to low platelet count
HUS can appear similar to several conditions including:
Disseminated intravascular coagulation
Investigations may include:
Baseline blood tests (FBC, U&E, CRP, clotting): may show thrombocytopenia, raised WCC, anaemia and acute kidney injury.
Urinalysis: to screen for haematuria and proteinuria.
Stool cultures: to screen for the presence of E.Coli O157.
The treatment of HUS is mainly supportive, the mainstay of treatment is the maintenance of fluid balance and correction of electrolyte abnormalities. Severe cases may lead to the development of renal failure requiring dialysis.
HUS is a notifiable disease to Public Health England, and should be reported to them within 3 days.⁶
Forceful coughing and/or vomiting
Forceful coughing or vomiting can cause petechiae to appear on the skin in the superior vena cava distribution, which is the head, neck and the top of the shoulders.
Other serious causes of petechiae should be excluded before they are attributed to forceful coughing or vomiting.
No management is needed and the petechiae should self-resolve.
When assessing children with non-blanching rashes it is important to consider the possibility of a non-accidental injury (NAI).
Certain distributions of ‘rashes’ should be suspicious for this such as hand marks, linear markings and those on the face/ears. They usually occur with other signs of NAI so careful examination is necessary.⁷
For more information on NAI, see the Geeky Medics article here.
Dr Thomas King
Dr Chris Jefferies
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Figure 1. Hektor. Purpura. License: [CC-BY-SA]. Available from: [LINK]
Figure 2. DrFO.Jr.Tn. Petechial rash. License: [CC-BY-SA]. Available from: [LINK]
Figure 3. Rosetheboston. Post gallbladder surgery bruise. License: [CC-BY-SA]. Available from: [LINK]
Figure 4. Madhero88. Henoch-Schonlein purpura. License: [CC-BY-SA]. Available from: [LINK]