supplemental appendix 4

Supplemental appendix 4

EXAMPLES OF BLEEDING MANIFESTATIONS*

Skin domain: slides 2 to 23Mucosal domain: slides 24 to 30Organ domain: slides 31 to 32

*Where not otherwise specified, pictures are taken from patients with primary ITP

1 cm 2 cm 3 cmActual scale:

Courtesy by M. Michel

A crop of scattered petechiae

Courtesy by F. Rodeghiero

Purpuric manifestations in a patient with septicemia and thrombocytopenia

Courtesy by F. Rodeghiero

Allergic (maculopapular) skin reaction secondary to cephalosporin (should not be recorded)

Courtesy by M. Michel

Recent scattered petechiae with confluence to form a purpuric macule (arrow)

Courtesy by F. Rodeghiero

Synchronous recent scattered petechiae. Abrupt presentation in ITP

Courtesy by F. Rodeghiero

Same patient. Synchronous recent scattered petechiae extending to the sole.

Courtesy by F. Rodeghiero

Petechiae of various size and age

Courtesy by F. Rodeghiero

Palpable purpura in a non thrombocytopenic patient

Courtesy by R. StasiPetechiae and one ecchymosis larger than a patient’s palm size

Six reddish-purple ecchymoses smaller than a patient’s palm size

Courtesy by M. Michel

Courtesy by M. Michel

Leg ecchymoses and scattered petechiae (not recent)

Courtesy by M. Michel

Several ecchymoses, one larger than patient’s palm size and no petechiae

Courtesy by F. Rodeghiero

Old ecchymosis, dating more than 10-15 days and a small, recent one

Courtesy by F. Rodeghiero

Extensive ecchymosis with underlying subcutaneous hematoma

Courtesy by F. Rodeghiero

Simmetrical ecchymoses with underlying subcutaneous hematomas caused by self-administered LMWH in a patient with ITP and moderate thrombocytopenia (should not be recorded)

Courtesy by F. Rodeghiero

Three old synchronous large ecchymoses and a few more recent petechiae

Courtesy by F. Rodeghiero

Ecchymoses of various age

Courtesy by F. Rodeghiero

Bullae and discoloration of skin not due to ITP (should not be recorded)

Courtesy by F. RodeghieroVaste ecchymosis secondary to constriction

Courtesy by F. Rodeghiero

Old small ecchymoses (sometimes seen in healthy people, purpura simplex)

Courtesy by F. Rodeghiero

An old ecchymosis

Courtesy by F. Rodeghiero

Very old ecchymosis (weeks) and some more recent petechiae

Courtesy by M. Michel

Hemorrhagic bullae of various age, two 1-day old on the left tongue margin

Courtesy by M. Michel

Hemorrhagic bullae of various age, two 1-day old on the left tongue margin

Courtesy by M. Michel

Old (2-3 days) hemorrhagic bullae and facial petechiae of various age

Courtesy by F. RodeghieroRecent hemorrhagic bullae (less than 2 days)

Courtesy by F. Rodeghiero

Sublingual recente ecchymosis

Partial hemorrhage in one eye and small peripalpebral ecchymosis in a patient with post-chemotherapy trombocytopenia

Courtesy by F. Rodeghiero

Bilateral peripalpebral ecchymoses and complete subconjunctival hemorrhage in a patient with post-chemotherapy trombocytopenia

Courtesy by F. Rodeghiero

Courtesy by M. Michel

Intracerebral hemorrage

Pictorial Blood Assessment Chart

In Rodeghiero et al, Haemophilia 2008; 14:68-75