What Is The Cause Of Small Red Blood Cells – Medically Reviewed by Avi Varma, MD, MPH, AAHIVS, FAAFP — Zawn Villines — Updated January 10, 2023

A purple rash occurs when small blood vessels burst, causing blood to pool under the skin. They appear as small, reddish-purple spots just below the surface of the skin.

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Purpura, also known as skin bleeding or blood spots, can signal several medical problems, ranging from minor injuries to life-threatening infections.

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Purpura is a physical sign of an underlying disease, not a disease in itself, with many possible causes.

Doctors often divide purpuric rashes into two categories based on the platelet count. Platelets are cell fragments that help blood clot more effectively, preventing dangerous bleeding.

, formerly called idiopathic thrombocytopenic purpura, is a form of purpura with an unknown cause. Patients with ITP experience destruction of platelets in the bloodstream. This leaves them at a higher risk of bleeding that creates the typical purpura rash.

One of the most studied variants of purpura is Henoch-Schönlein purpura, a non-thrombocytopenic version of purpura. More common among young children, this type of purpura often precedes a respiratory infection.

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Symptoms often disappear on their own. However, some people with Henoch-Schönlein purpura suffer from dangerous inflammation that leads to kidney problems.

Over time, the reduction of subcutaneous fat and connective tissue and prolonged sun exposure can lead to increased bruising in mature skin due to minor trauma. This is known as actinic purpura. Other names for this include solar purpura, senile purpura, traumatic purpura, and Bateman’s disease.

Of those 90–100 years. It may also be more common in people taking aspirin, anticoagulants, or nonsteroidal anti-inflammatory drugs (NSAIDs).

These patches of broken blood vessels may appear dark purple or brown. However, they usually fade within 1 to 2 weeks. Some hyperpigmentation may remain after the purpura disappears.

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This type of purpura does not require treatment. However, a person can talk to their doctor or dermatologist about options to reduce or improve the appearance of these marks.

To treat purpura, doctors must determine its cause. Purpura that is not associated with low platelet levels (nonthrombocytopenic purpura) has a number of causes and risk factors, including:

ITP occurs when the body attacks its own platelets, increasing the risk of bleeding and purpuric rashes. A low platelet count in newborns whose mothers have ITP can also lead to purpura.

Diseases that damage bone marrow function can limit the body’s ability to make platelets and attack the bone marrow, such as:

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Small purple spots on the skin, typically 4-10 millimeters (mm) in diameter, characterize purpura. Some people develop areas of freckles

. They are called petechiae. Some people develop larger spots of 1 centimeter (cm) or more. This is called ecchymosis.

The main symptom of purpura is a purple-red rash under the surface of the skin. This rash may appear dark brown or black on darker skin tones. The rash can appear anywhere on the body, including mucous membranes such as the lining of the mouth.

Purpura usually occurs in clusters that are in one area or cover a large part of the body. The bigger the rash, the more bleeding there will often be.

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Unlike other rashes, purpura will not change color or fade when pressed. The rash may resemble tiny clusters of bruises. Although the skin will not itch or hurt in many cases, it can sometimes be sensitive or irritated.

Purpura spots are quite easy to distinguish from other rashes. Purpura does not have to appear with itching or skin symptoms. Finding the root cause of purpura can be difficult.

Several routine tests, starting with a complete blood count (CBC), help investigate the cause of purpura. A CBC will reveal if the patient has low platelets and if there are any underlying infections.

If the doctor suspects ITP, he may order additional testing. Certain clinical situations may require bone marrow testing. A skin biopsy can also provide important information, especially when the doctor cannot find the underlying cause of the purpura.

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Some forms of skin cancer look similar to the purple spots of purpura. A biopsy can rule out skin cancer.

If a doctor suspects Henoch-Schönlein purpura, urine tests can evaluate kidney function by testing for protein and blood in the urine.

Not all cases of purpura require immediate treatment. Doctors often choose to observe the patient for other symptoms to see if they go away on their own. Children who have Henoch-Schönlein purpura are often likely to get better without treatment.

When treatment is needed, it is not because of the rash itself. It is necessary to treat the underlying causes, such as leukemia, as well as the consequences, such as kidney failure.

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In some cases, doctors may recommend nonsteroidal anti-inflammatory drugs to reduce inflammation and pain. However, people with gastrointestinal or kidney problems should avoid these drugs.

Steroid treatment can reduce kidney damage and abdominal pain. Doctors may prescribe drugs to suppress the immune system if kidney damage is severe.

Treatments vary depending on a person’s specific needs, so all medications and treatments should be discussed with a doctor.

, and some patients do not need treatment. Those who do may benefit from drugs designed to increase platelet counts or, in rare cases, removal of the spleen.

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Medicines that suppress the immune system, such as prednisone, can help increase platelet levels. In patients with platelet counts low enough to be life-threatening, doctors may offer immunoglobulin treatment.

Treatment of other forms of purpura is aimed at addressing the underlying cause rather than the skin manifestation. This may include options such as chemotherapy, antiviral drugs, steroid drugs, antibiotics, and surgery.

Corticosteroids can help increase the number of platelets by reducing the activity of the immune system. Typically, a person will use corticosteroids for

If purpura is causing significant bleeding, intravenous immunoglobulin can help increase platelet levels. This treatment is usually only effective in the short term. This medicine can also help treat purpura in people who are resistant to corticosteroid therapies.

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These are the latest drugs to treat ITP. Both romiplostim (Nplate) and eltrombopag (Promacta) stimulate the bone marrow to

Rituximab (Rituxan) helps reduce the immune response. They mainly treat thrombocytopenic purpura and patients who do not respond to corticosteroids. Side effects include sore throat, low blood pressure, fever and rash.

When the cause of the purpura is an incurable medical condition, it may be necessary to check platelet levels and organ function.

When purpura is the result of a blood clotting condition, the untreated disorder can cause life-threatening bleeding. Prompt diagnosis and treatment of the underlying cause can reduce the patient’s risk of serious complications.

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Kidney damage can occur in people with Henoch-Schönlein purpura; this damage may require dialysis or a kidney transplant and can become life-threatening without treatment.

Henoch-Schönlein purpura can also cause a rare condition in which the bowel folds; this creates an intestinal obstruction that limits digestion. Bowel obstruction can be fatal if left untreated.

Purpura itself is not a disease — it is a physical sign of another problem. The only effective method to prevent purpura is to avoid the conditions that cause it. Since most of these conditions are not due to lifestyle factors, there is little that a person can do to reduce the risk of purpura.

Purpura is a collection of small pools of blood under the skin. They occur when blood vessels burst near the surface of the skin and may appear red, purple or black. Purpura is a symptom, not a condition itself.

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People may call these presentations skin bleeds or blood spots. Purpuras are often the result of a minor injury and disappear on their own. However, they can also mean serious medical conditions such as immune disorders and infections.

Medical News Today has strict sourcing guidelines and only uses peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link to primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and up-to-date by reading our editorial policy. Hematochezia refers to the passage of fresh, bright red blood in the stool and usually indicates bleeding originating in the lower gastrointestinal (GI) tract. The lower GI tract is anatomically defined as the region distal to the ligament of Treitz, which is a thin band of tissue that connects and supports the end of the duodenum and the beginning of the jejunum. Hematochezia should not be confused with melena, which refers to the passage of black, tarry stool that originates in the upper GI tract, which is located proximal to the ligament of Treitz.

Causes of hematochezia in adults usually include inflammatory bowel disease (IBD), including ulcerative colitis; hemorrhoids; and bleeding from a diverticulum in the colon. In addition, peptic ulcer and esophageal varices are causes of upper gastrointestinal bleeding that can cause hematochezia when severe.

Ulcerative colitis is a subtype of inflammatory bowel disease that involves an autoimmune attack on the large intestine (ie, large intestine), leading to inflammation and ulcers in the lining. Severe ulcerative colitis can result in hematochezia due to bleeding from the ulcer.

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Hemorrhoids are swollen veins in the lower rectum and can be painless or painful, depending on whether they are

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