hemorrhagic vasculitis - a disease associated with damage to the body's smallest blood vessels: capillaries, venules and arterioles.It is accompanied by a hemorrhagic vasculitis aseptic inflammation and structural breach organization of small caliber vascular walls.As a result of damage to the walls of the venules, arterioles and capillaries increased the risk of thrombosis.Suffer the small vessels of the skin and internal organs.The defeat of the skin capillaries leads to a kind of rash, and therefore hemorrhagic vasculitis is also called allergic purpura.The disease occurs mainly in children and / or patients younger than 20 years.The peak incidence of hemorrhagic vasculitis usually occurs in the spring.
In 1832, was first described by physician Shenlyaynom hemorrhagic vasculitis, and later, in 1874, wrote a scientific paper on the topic of the disease by Dr. Henoch.In their honor, a hemorrhagic vasculitis is also called the disease Shenlyayn-Henoch.
hemorrhagic vasculitis causes
trigger in the event of hemorrhagic vasculitis considered transferred upper respiratory tract infection.The most common pathogens are hemolytic streptococcus infection, respiratory viruses, mycoplasma.However, not only these pathogens provoke allergic reactions in the form of hemorrhagic vasculitis.In the role of a trigger can serve the vaccine, some types of drugs, food allergies, insect bites, hypothermia, burn disease.There are cases of hemorrhagic vasculitis in response to receiving streptomycin, penicillin, sulfonamides, barbiturates, quinine.
For the occurrence of hemorrhagic vasculitis also need a special condition of the immune system.Man is prone to atopic reactions and allergies.It contributes to hemorrhagic purpura.
immune system activates a number of substances, the so-called complement system, which attack the components of the vascular wall.The resulting immune complexes are introduced into the damaged wall.The activation of the blood coagulation process, which leads to the formation of microthrombi.Since the vessel walls ceases to be complete, the blood cells are located in the tissue, thereby forming a hemorrhagic syndrome.
hemorrhagic vasculitis may accompany metabolic disorder.Pregnancy is a factor that contributes to the emergence of hemorrhagic vasculitis.A woman's body during this period is subject to various influences from the outside.This may occur when placental abruption, fetal hypoxia, growth retardation.
hemorrhagic vasculitis symptoms
When hemorrhagic vasculitis develops a large number of symptoms.In the initial stages there is high fever with figures and a severe headache.The patient was concerned about pain in large joints.In the stomach, pain and discomfort of uncertain location.There is frustration of a chair.Over time, high fever is replaced by low-grade fever.
hemorrhagic vasculitis in the early days of the disease may not manifest itself in any way.After some time on the body start to appear hemorrhage, the location may be different.Eruptions monotonous, have the form punctate purple, which tends to merge.Elements of the rash is most often located in the field and a natural skin trauma, ie,on the inner thighs, on the hands, feet, seat belt in place, and others.
rash at hemorrhagic vasculitis symmetrical and accompanied by itching.Sometimes the background of hemorrhagic purpura may experience other elements of the rash: blisters, bullae, angioedema.In severe cases, the lesions are converted into erythema and necrotic, resulting in formation of ulcers on the skin.Peak rash lasts for two days.Then the elements of the rash regress, becoming a purple, and then become brown.This painting shows the degradation of hemoglobin extravascular erythrocytes.With progression of hemorrhagic vasculitis rash may occur in waves, about 3-4 times.
Articular Syndrome causes in hemorrhagic vasculitis pain in the large joints.They tend to suffer knee and ankle joints.The pain can be so severe that the patient is immobilized for a while.This objective radiographic evidence of joint diseases, no.In rare cases may occur hemarthrosis, which are visible on x-ray images.Arthralgia in hemorrhagic vasculitis are transient.In rare cases, may cause the emergence of a stable pain symptoms.But most of the duration of the painful joint symptoms less than 2 weeks.
emergence of abdominal syndrome in hemorrhagic vasculitis is caused by bleeding in the intestinal wall and mesentery impregnating blood cancer.This is manifested in the form of nausea, vomiting, malabsorption of nutrients from food, flatulence.Often, such a manifestation of hemorrhagic vasculitis can be confused with acute pancreatitis, cholecystitis, appendicitis.There may be a liquid bloody stools, vomiting streaked with blood.The risk of abdominal symptoms is reduced to the appearance of complications such as peritonitis, bowel perforation and bleeding.
Kidney damage in hemorrhagic vasculitis associated with the formation of blood clots in the capillaries of the renal glomeruli.The result is a glomerulonephritis.The first symptoms of glomerulonephritis may occur after the extinction of the above symptoms.Against the backdrop of the apparent prosperity begins hematuria.Immunodependent glomerulonephritis often progresses to kidney failure.A renal failure is known to be chronic in waves.Over time, it developed a hypertensive, proteinuric syndrome.But such an outcome is characteristic of the disease for patients with hemorrhagic vasculitis of middle age.
Quite rarely develop symptoms of pulmonary lesions on the background of hemorrhagic vasculitis.In this case there is abundant pulmonary hemorrhage.On radiographs revealed plots infiltrated lung tissue.Sometimes there may be bleeding in the brain with symptoms of acute cerebral.There have been cases of suffocation when angioedema of the larynx.
notes the following variants of clinical course of hemorrhagic vasculitis:
1) is characterized by lightning for the emergence and development of symptoms within a few hours;
2) acute hemorrhagic vasculitis develops in a few days;
3) prolonged duration of symptoms characteristic manifestation of a long time, regardless of the treatment;
4) is characterized by recurrent variants of wave-like exacerbations;
5) chronic persistent option appears the constant presence of petechiae on the skin.
hemorrhagic vasculitis in children
Parents may notice yourself beginning of hemorrhagic vasculitis.It begins, like most dangerous diseases, symptoms of general malaise.At this stage, it is important to see a doctor, which will be confirmed and disproved fears of parents.
restless child or on the contrary, there is increased fatigue, he has no appetite.Previously, active and restless baby is passive and has no interest in toys.Parents may find swelling and increase knee and ankle joints.The temperature increased.The kid complaining of abdominal pain.
A few days later a rash appears on the skin.They are located on the flexor surfaces of the extremities.If hospitalization has not been carried out previously, at this stage it is necessary to address urgently to the hospital.Self-medication in this case could exacerbate the situation.Children often hemorrhagic vasculitis caused by allergic reactions.So you need as quickly as possible to eliminate the allergen.
after admission 95% of the children recover, and hemorrhagic vasculitis and its consequences does not bother them anymore.
For the prevention of hemorrhagic vasculitis is necessary to engage in sports, tempered.It is necessary to protect the child from allergies and less unreasonable to take drugs.
forms of hemorrhagic vasculitis
clinical manifestations of hemorrhagic vasculitis may be differences.Different people prevails a given syndrome.Therefore, we identified several forms of this disease, as different clinical course requires specific therapy.Accepted provide the skin, skin and joints, abdominal, renal, and mixed forms of hemorrhagic vasculitis.
to combined combinations usually include skin-joint version of the disease, which is also called simple.
Depending on the course, this condition can be acute (lasting 30-40 days.), Lightning (developed over the matter of days), prolonged (lasting longer than two months), recurrent (signs of the disease appear repeatedly 3-4r. Overthe next few years) and chronic (symptoms persists for more than one and a half years, with occasional / frequent exacerbations).
diagnosis of hemorrhagic vasculitis includes history, which indicated the presence of a previous infection, taking medicines, vaccination.There is also a simple way to diagnose purpura using a cuff.It inflates the cuff as long as the radial pulse will be felt minimal.After a few minutes the cuff was removed.The test is considered positive when the forearm there are small hemorrhages.This is due to increased traumatization vessels at hemorrhagic vasculitis.You can check for hemorrhagic vasculitis with a strong compression of the area of the skin - the symptom "pinch".
In the hospital uses biomicroscopy of bulbar conjunctiva with revealing the so-called phenomenon of sludge.
Blood tests show a small increase in white blood cells, leukocyte formula shift to the left.Determined anemic syndrome with massive hemorrhages, increased erythrocyte sedimentation rate.The urine is determined by a large number of protein, erythrocyte cylinders.
Biochemical analysis of blood of a patient with hemorrhagic vasculitis indicates an increase in the alpha and gamma-globulin, fibrin, fibrinogen.Several times the concentration in the blood coagulation von Willebrand factor, which is produced in endothelial cells.
Endoscopic examination of the bowel in patients with hemorrhagic vasculitis reveals petechial hemorrhages in the mucosa.
When performing skin biopsies revealed infiltrates that contain immunoglobulins.
Before a diagnosis of hemorrhagic vasculitis, it is necessary to make a differential diagnosis.In the case of abdominal form of hemorrhagic vasculitis, it is necessary to differentiate from acute appendicitis, pancreatitis, cholecystitis, bowel obstruction, peritonitis.The cutaneous form of the disease is manifested hemorrhagic rash, which may be in meningococcal meningitis, paraneoplastic syndromes, cryoglobulinemic vasculitis, sepsis, thrombocytopenia.
hemorrhagic vasculitis treatment
All patients with hemorrhagic vasculitis should be hospitalized in the acute stage.It is necessary to avoid hypothermia and loads on the legs.During treatment, immunizations and vaccines excluded.It should always be remembered that many of these patients are contraindicated medications, such as antibiotics, vitamin complexes, sulfonamides, aminocaproic acid, calcium supplements, and others.
all foci of infection require immediate remediation.However, antibiotic therapy should not be unfounded.
introduce Heparin subcutaneously at a dose of 2500-5000 IU of multiplicity p 2-4 in the day.In case of failure of the dosage should be increased to her daily dose in IU 30000-40000.The duration of treatment of cutaneous forms of 3 weeks.Renal form requires heparin treatment for 6 weeks.You can also use Fraksiparin and Fragmin.In the treatment of hemorrhagic vasculitis anticoagulants should be regularly tested for blood clotting.
used as antiplatelet agents aspirin at a dose of 75 mg d, ticlopidine 0.2 g multiplicity 3 r in g Dipiridomol, clopidogrel.
increased to suppress the platelet aggregation inhibitors of thromboxane used (Ridogrel), thrombin receptor blockers (Vaniprost) thrombin receptor antagonists (Absiksimab, Tirofiban, Integrilin) for 6 months.
pretty good results are obtained after taking dapsone (50-100 mg for 2 p in d), together with pentoxifylline (0.4 g p 3 in the village).These preparations are used within 5-6 days, followed by an interval of 1 day.
Itching effectively eliminated by antihistamines: Tavegil (0.001 g multiplicity p 2 in the village), Suprastin (0,025 multiplicity p 3 in the village).
Like all allergic diseases, hemorrhagic vasculitis should be treated starting with cleansing the body of unnecessary metabolic products.To cleanse the digestive tract used sorbents.Everyone knows the sorbent is activated carbon.There are also such as the sorbents Laktofiltrum, Enterosgel.It is also possible to use white carbon, it is increasingly customary coal several times.
effective against hemorrhagic vasculitis histamine receptor blockers.Histamine - a biologically active substance which is responsible for the development of an allergic reaction.It accumulates in the so-called "fat" cells.When the allergen enters the body, mast cells are activated.Of these, begins to stand out histamine.The blockade of histamine receptors, histamine is not released from the cells and there is no reaction to the allergen.Histamine receptors are found on the membranes of smooth muscle cells and control spasmodic reaction.As a result of the blockade does not increase the permeability of the vessel walls, are not involved in blood cells responsible for the immune response.
Antihistamines are produced for a long time and are divided into three generations, having as a sedative, anticholinergic, atropine effect, which is very important in the treatment of hemorrhagic vasculitis.Such actions of this group of drugs are due to hit them in the central nervous system.Histamine receptor blockers are the first generation have some disadvantages, such as incomplete connection with the receptors and therefore have to use higher doses;as well as short-term effect and sedative effect.This group of drugs include Tavegil, diphenhydramine, promethazine, Moksantin.
of second-generation antihistamine action does not penetrate into the nervous system, so they are not peculiar side effects.However, their action is directed directly to the histamine receptors.This group includes Dezloratodin, fexofenadine, Tsitirizin.
Another method of treatment of hemorrhagic vasculitis, as a result of an allergic reaction - infusion therapy.This method is based on dilution of the blood circulation and reducing the concentration of allergen and the immune complexes.However, this method should be used with caution in patients with chronic renal failure, which may occur in hemorrhagic vasculitis.All preparations for infusion therapy must be chosen carefully.Since colloidal solutions themselves can cause allergies, and they are contraindicated in patients with renal insufficiency.For infuzionnay therapy of hemorrhagic vasculitis need to use crystalloid solutions which are dissolved sugar and electrolytes.In this situation, the following drugs are useful: sodium chloride as saline.Saline solutions of potassium contraindicated in violation of renal function and marked acidosis.
calcium salts may be used in hemorrhagic vasculitis, since they are antagonists potassium.In marked shift towards blood acidic environment, it is necessary to assign Sodium bicarbonate in the form of a hypertonic solution (4.2%).