The bleeding can be caused by many different things, but one common explanation is due to thrombocytopenia -- the platelet count is so low that bleeding occurs or it can be caused by blood vessel damage. Purpura is a clinical sign rather than a diagnosis, and therefore the patient should be examined for other signs and symptoms and a differential diagnosis should be constructed, as there can be many causes including meningococcal disease, disseminated intravascular coagulation and vasculitis syndromes. It is worth considering the differential classified into vascular and thrombocytopenic causes.
Some self-limiting causes of petechiae around eyes, mouth or head could be due to excessive vomiting or coughing, but other symptoms should be examined. Further history taking, examination and lab testing will aid the narrowing of the differential diagnosis. Tests to consider include a full blood count, platelet count, prothrombin and bleeding time.
Purpuric rash causes for consideration in your differential diagnosis work up can be seen by using Isabel in this case with a child aged 6-12 years.
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