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Wet Purpura, Dry Purpura

William H. Crosby, MD
JAMA. 1975;232(7):744-745. doi:10.1001/jama.1975.03250070040025.
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Thrombocytopenic purpura is one of few hematologic disorders that may be a five-alarm emergency. It is potentially fatal, yet potentially curable. Adequate intervention can mean the difference.

Evaluation of the case need not take long. Look at the patient. Look at a blood smear. Do a platelet count. Aspirate bone marrow from the sternum. (At the sternum, bleeding can be controlled by finger pressure. From a hole in the posterior iliac crest a patient with thrombocytopenia can lose a liter of blood. I have seen a hematoma that extended from knee to axilla.)

Examination of the patient permits a most critical determination. Is it wet purpura or dry purpura? In either variety the platelet count may be 5,000/cu mm or less, but in wet purpura the patient is bleeding: the gums ooze, or the nose bleeds, or there may be blood blisters in the mouth, all of which cause guaiac-positive


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