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288 Cards in this Set
- Front
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blood type:
universal recipients |
AB+
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blood type:
universal donor |
O-
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MCC of anemia
|
IDA
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best initial test for anemia
|
CBC
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symptoms when hematocrit is:
>30 |
none
|
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symptoms when hematocrit is:
25-30 |
dyspnea
fatigue |
|
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symptoms when hematocrit is:
20-25 |
light headed
angina |
|
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symptoms when hematocrit is:
<20 |
syncope
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what is the only anemia with high reticulocyte count
|
alpha thalassemia with 3 gene deletion
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when should a px with anemia be transfused
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symptomatic
very low hct in elderly heart disease |
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what is meant by symptomatic in anemia
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shortness of breath
light headed, confused, syncope hypotension and tachycardia chest pain |
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how much does each unit of packed RBC increase the Hct
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3 points per unit
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what should be suspected if a patients hematocrit does not rise after giving packed RBC
|
px is still bleeding
|
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what is fresh frozen plasma used for
|
replace clotting factors
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what is cryoprecipitate rich in
|
factor 7, 13, vW and fibrinogen
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Dx:
anemia with RA |
AOCD
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Dx:
anemia with no symptoms |
thalassemia
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symptoms of lead poisoning
|
abdominal pain
arthralgia peripheral neuropathy gingival lead lines |
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what can cause lead poisoning in children
|
early or excess use of cows milk
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serum iron, ferritin and TIBC in:
IDA |
dec
dec inc |
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serum iron, ferritin and TIBC in:
lead poisoning |
N/inc
N N |
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serum iron, ferritin and TIBC in:
AOCD |
dec
N/inc dec |
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serum iron, ferritin and TIBC in:
sideroblastic anemia |
inc
inc dec |
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serum iron, ferritin and TIBC in:
thalassemia |
N/inc
N N |
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MCC of siderblastic anemia
|
alcohol
|
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what lab value can help suggest AOCD
|
inc ESR
|
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how much iron is needed in:
normal person |
1-2 mg
|
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how much iron is needed in:
menstruating women |
2-3
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how much iron is needed in:
pregnant women |
5-6
|
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how much iron can the duodenum absorb in a day
|
4
|
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what should always be done in px with IDA
|
check for occult blood in stool
|
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anemia a/w:
low ferritin |
IDA
|
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anemia a/w:
high iron |
sideroblastic anemia
|
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anemia a/w:
normal iron studies |
thalassemia
|
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what is the next best test after microcytic anemia is determined by CBC
|
iron studies
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what is the MCC of death by poison
|
iron
|
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pathophys of iron toxicity
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accumulates in mitochondria
causes lactic and citric acidosis |
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what does hepcidin do
|
inhibits absorption and mobilization of iron
|
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symptoms of iron toxicity after:
3-6 hours |
mucosal damage
|
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symptoms of iron toxicity after:
6-72 hours |
met acidosis
|
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symptoms of iron toxicity after:
12-96 hours |
hepatotoxicity
|
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most accurate test for IDA
|
BM biopsy
|
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what do reticulocytes stain with
|
methylene blue
|
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most accurate test for sideroblastic anemia
|
BM biopsy
w/ prussian blue staining for ringed sideroblasts |
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most accurate test for thalassemia
|
hemoglobin electrophoresis
(alpha thalassemia is genetic studies) |
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findings in a thalassemia with 1 gene deletion
|
normal
|
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findings in a thalassemia with 2 gene deletion
|
mild anemia
normal electrophoresis |
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findings in a thalassemia with 3 gene deletions
|
hemoglobin H (beta 4 tetrads)
|
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findings in a thalassemia with 4 gene deletions
|
hemoglobin Bart (gamma 4 tetrad)
hydrops fetalis |
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findings in B thalassemia with 1 gene deletion
|
increased hemoglobin F and A2
|
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Rx for IDA
|
oral ferrous sulfate or intramuscular iron
|
|
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SE of giving iron
|
black stool
constipation |
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Rx for sideroblastic anemia
|
B6
adults: -succimer -EDTA children -dimercaprol -succimer -EDTA |
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Rx for B thalassemia major
|
lifelong transfusion
|
|
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Rx for iron overload because of chronic transfusion
|
deferoxamine
deferasirox |
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what should be suspected if px has a microcytic anemia that doesnt respond to iron
|
thalassemia
|
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once a macrocytic anemia has be determine what is the next best test
|
peripheral smear
|
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what levels are unique to B12 and not folate def
|
increased methylmelonic acid
|
|
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Rx for B12 def caused by D latum
|
praziquantel
|
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MCC of megaloblastic anemia
|
alcoholics
|
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what vitamin are vegetarians def in
|
B12
|
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what vitamin are is goats milk def in
|
folate
|
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MC vitamin def
|
folate
|
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Rx for folate def caused by MTX
|
folinic acid (Leucovorin)
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how long do B12 stores last
|
4-5 years
|
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what are px with B12 def caused by gastritis at increased risk for
|
gastric cancer
|
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how does B12 def cause neurological problems
|
causes defective myelin synthesis
|
|
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what can cause subacute combined degeneration of the cord
|
B12 def
syphilis |
|
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what neurologic problems do px with B12 def have
|
posterior column damage
-position -vibration |
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next best step in px with macrocytic anemia and equivical B12 and folate levels
|
methylmalonic acid level
|
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potential complication when replacing B12 or folate
|
hypokalemia
|
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why are pancreatic enzymes needed to absorb B12
|
removes R protein from B12
|
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what lab changes are found in all forms of hemolysis
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increased LDH, indirect bilirubin and reticulocytes
decreased haptoglobin |
|
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what does haptoglobin do
|
takes newly released hemoglobin and recycles it
|
|
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MCC of autoimmune hemolysis
|
warm agglutinins
|
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what hematological pathologies cause bilirubin gallstones
|
chronic hemolysis
sickle cell spherocytosis |
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what is the mutation in SC
|
point mutation in position 6 of beta globin chain
valine replaces glutamic acid |
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what occurs in px with SC and are pregnant
|
frequent UTI
|
|
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MCC of sepsis in SC
|
S pneumo
|
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what should be given to children with SC
|
prophylactic penicillin until 5 yo
|
|
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how do children with SC present
|
symmetric dactylitis
(inflammation of fingers) |
|
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what can cause acute painful vasoocclusive crisis
|
hypoxia
dehydration infection cold temperature |
|
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what is defective if spleens are missing in px with SC
|
Ab mediated opsonization (phagocytosis)
|
|
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what should be done in SC px with low reticulocyte count
|
check parvo virus
check for folate def |
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what are some common complications of SC
|
retinopathy
stroke enlarged heart with systolic murmur lower extremity skin ulcer avascular necrosis |
|
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MCC of stroke in children
|
SC
|
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what are the common vessels to have avascular necrosis in SC and where are they found
|
ascending and foveal artery
lie in ligamentum teres |
|
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best initial test for SC
|
peripheral smear
|
|
|
most accurate test for SC
|
electrophoresis
|
|
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what is seen on radiology in SC
|
fish mouth vertebrae
lung infiltrates |
|
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what causes strokes in SC px
|
RBC adherence to endothelium
activation of vWF hyperviscosity |
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what are howell jolly bodies
|
precipitated remnants or nuclear material inside RBC
|
|
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Dx
morulae seen inside neutrophils |
ehrlichia
|
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why do SC px need high levels of folate
|
to maintain reticulocytes
|
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what should be done in SC px with fever
|
immediate antibiotics
|
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how is aplastic crisis prevented in SC px
|
folate replacement
|
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how is sickle cell crisis prevented
|
hydroxyurea
|
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what vaccine should all SC px recieve
|
pneumococcal vaccine
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best initial Rx for SC px
|
oxygen/hydration/analgesics
|
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when is exchange transfusion needed in SC px
|
severe vasoocclusive crisis with:
-acute chest pain -priapism -stroke -visual disturbance |
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what is the first clue to parvo infection in SC px
|
sudden drop in reticulocyte count
|
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HbS concentration in SC trait px
|
35-40%
|
|
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complications of SC trait
|
isosthenuria (clogged vasa rectae)
hematuria (papillary necrosis) |
|
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most accurate test for hereditary spherocytosis
|
osmotic fragility test
|
|
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Rx for hereditary spherocytosis
|
folic acid replacement
splenectomy |
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why is it important to do a coombs test to px with hereditary spherocytosis
|
autoimmune hemolysis also has spherocytes
|
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what lab levelsare found in hereditary spherocytosis
|
low MCV
high MCHC (>36%) |
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causes of warm autoimmune hemolysis
|
CLL
lymphoma SLE drugs |
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most accurate diagnostic test for autoimmune hemolytic anemia
|
coombs test
|
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best initial therapy for warm hemolysis
|
steroids
if not, IVIG |
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Rx for recurrent warm hemolysis
|
splenectomy
if not, rituximab |
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what is a/w cold agglitinins
|
EBV
waldenstrom mycoplasma |
|
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diagnostic test for cold agglutinins
|
direct coombs
|
|
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Rx for cold agglutinins
|
stay warm
RBC transfusion rituximab immunosuppressive agents |
|
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what are some features of cryoglobulinemia
|
hep C
joint pain glomerulonephritis |
|
|
Rx for cryoglobulinemia
|
Rx the hep C that caused it
|
|
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what is the pathophys of G6PD def
|
inability to generate glutathione reductase
|
|
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what is found in the urine after a hemolytic episode in G6PD def
|
hemosiderin
|
|
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what stains hemosiderin
|
prussian blue
|
|
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what is used to stain heinz bodies
|
crystal violet
|
|
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best initial test for G6PD def
|
blood smear looking for heinz bodies and bite cells
|
|
|
most accurate test for G6PD def
|
G6PD level after waiting 1-2 months after an acute episode of hemolysis
|
|
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what are heinz bodies
|
aggregates of denatured hemoglobin
|
|
|
symptoms of HUS
|
renal failure
thrombocytopenia hemolytic anemia |
|
|
symptoms of TTP
|
renal failure
thrombocytopenia hemolytic anemia neurologic problems fever |
|
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Rx for HUS/TTP
|
plasmapheresis or plasma exchange
|
|
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how can recovery be measured in HUS/TTP
|
normalization of platelet count and LDH level
|
|
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what can cause HUS
|
e coli
shigella |
|
|
what can cause TTP
|
AIDS
drugs (ticlopidine, clopidogrel, cyclosporine) |
|
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what is the best test for HUS/TTP
|
blood smear
-looking for schistocytes |
|
|
pathophys of paroxysmal nocturnal hemoglobinuria
|
deficiency in CD 55 and 59 (DAF)
Defective PIG-A (GP1 anchor protein) |
|
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where do thrombus usually form in paroxysmal nocturnal hemoglobinuria
|
hepatic vein
|
|
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features of paroxysmal nocturnal hemoglobinuria
|
episodic dark urine on first urination
pancytopenia iron deficiency |
|
|
MCC of death in paroxysmal nocturnal hemoglobinuria
|
thrombosis
|
|
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what is the most accurate test for paroxysmal nocturnal hemoglobinuria
|
flow cytometry (decreased CD 55 and 59 levels)
|
|
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best initial therapy for paroxysmal nocturnal hemoglobinuria
|
steroids
|
|
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only way to cure paroxysmal nocturnal hemoglobinuria
|
BM transplant
|
|
|
what can be used to inhibit compliment in paroxysmal nocturnal hemoglobinuria
|
eculizumab
-inactivates C5 |
|
|
how does aplastic anemia present
|
pancytopenia
-infection -anemia -bleeding |
|
|
most accurate test for aplastic anemia
|
BM biopsy
|
|
|
what is seen on BM biopsy in aplastic anemia
|
hypocellularity with fatty infiltrates
|
|
|
MCC of congenital aplastic anemia
|
fanconis anemia
|
|
|
features of faconis anemia
|
kidney malformation (horseshoe)
hypo/hyper pigmentation abnormal thumb short stature ear conduction defect |
|
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how is fanconis anemia diagnosed
|
genetic analysis shows chromosomal breaks
|
|
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what causes the chromosomal breaks in fanconis anemia
|
diepoxybutane
|
|
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what is the pathophys in aplastic anemia
|
T cells attack patients own marrow
|
|
|
Rx for aplastic anemai
|
supportive therapy
-transfusions -platelets -antibiotics BM transplant -if older than 50 or no match, Rx with antithymocyte globulin and cyclosporine (or tacrolimus) |
|
|
MCC of increased RBC
|
chronic hypoxia
|
|
|
what must be excluded in polycythemia vera
|
chronic hypoxia
|
|
|
what is the pathophys of polycythemia vera
|
JAK2 protein mutation
|
|
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why do px with polycythemia vera develop pruritus after hot showers
|
increased basophils release histamine
|
|
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what are some lab abnormalities in polycythemia vera
|
increased Hct (above 60%)
MCV is low Normal O2 decreased EPO ESR close to 0 |
|
|
most accurate test for polycythemia vera
|
check for JAK2 mutation
|
|
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MCC of polycythemia in newborn
|
delayed clamping of umbilicus
|
|
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what nutrient abnormalities do px with polycythemia have
|
increased B12
decreased iron |
|
|
Rx for polycythemia
|
phlebotomy
hydroxyurea antihistamines (pruritus prevention) ASA (thrombus prevention) |
|
|
what is essential thrombocytosis
|
platelet count above 1 million
|
|
|
when essential thrombocytosis treated
|
only treat if
-symptomatic -platelets are above 1.5 million ->60 yo and thrombosis |
|
|
best initial Rx for essential thrombocytopenia
|
hydroxyurea
|
|
|
Rx for RBC suppression by hydroxyurea
|
anagrelide
|
|
|
Rx for erythromelalgia
|
aspirin
|
|
|
what is erythromelalgia
|
painful red hands
|
|
|
Rx for myelofibrosis
|
thalidomide and lenalidomide
if under 50-55 BM transplant |
|
|
what is seen on BM biopsy in myelofibrosis
|
hypocellular fibrotic BM
|
|
|
a/w tear drop shaped cells
|
myelofibrosis
|
|
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how does acute leakemia present
|
symptoms of pancytopenia
-fatigue -infection -bleeding previous history of myelodysplastic syndrome |
|
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which leukemia is a/w DIC
|
M3 AML
|
|
|
best initial test for acute leukemia
|
blood smear showing blasts
(25% lymphoblasts is diagnostic) |
|
|
most accurate test for acute leakemia
|
flow cytometry
|
|
|
translocation in M3 AML
|
15:17
|
|
|
what is defected in AML
|
retinoic acid receptor
|
|
|
associated with auer rods
|
AML
|
|
|
leukemia a/w bleeding gums
|
M5 AML
|
|
|
leukemia positive for a-naphthyl esterase
|
M5 AML
|
|
|
leukemia postive for myeloperoxidase
|
M3 AML
|
|
|
best initial Rx for acute leukemia
|
chemo
if poor prognosis give BM transplant if good prognosis give more chemo |
|
|
best indicator of prognosis in acute leukemia
|
cytogenetics
|
|
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which leukemia should recieve an additional MTX
|
ALL
|
|
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presentation of CML
|
high WBC count that is all neutrophils
pruritus splenomegaly |
|
|
how can CML and leukomoid reaction be differentiated
|
LAP is low in CML
LAP is high in leukomoid reaction |
|
|
what is the mutation in CML
|
BCR-ABL 9:22
tyrosine kinase |
|
|
best initial Rx for CML
|
tyrosine kinase inhibitors (bind to ATP binding site)
(imatinib, dasatinib, nilotinib) |
|
|
which myeloproliferative disorder is most like to transform to acute leukemia
|
CML
|
|
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how can CML transformation to acute leukemia be prevented
|
tyrosine kinase inhibitors (bind to ATP binding site)
(imatinib, dasatinib, nilotinib) |
|
|
what is most effective Rx to cure CML
|
BMT
|
|
|
what is usually abnormal in myelodysplastic syndrome and how does this effect the prognosis
|
5q deletion
(better prognosis when present) |
|
|
MCC of death in myelodysplastic syndrome
|
infections and bleeding
|
|
|
how does myelodysplastic syndrome present
|
px over 60 with asymptomatic pancytopenia despite and hypercellular BM
|
|
|
a/w pelger huet cells
|
myelodysplastic syndrome
|
|
|
what determines the severity of myelodysplastic syndorme
|
percentage of blasts
|
|
|
what are pelger huet cells
|
bilobed nucleus
neutrophils with nuclei with 2 lobes connected by a thin strand |
|
|
Rx for myelodysplastic syndorme
|
transfusion
EPO lenalidomide |
|
|
what can decrease transfusion dependence in those with myelodysplastic syndorme
|
lenalidomide
|
|
|
presentation of CLL
|
proliferation of B lymphocytes
lymphadenopathy hepatosplenomegaly infection |
|
|
a/w smudge cells
|
CLL
|
|
|
a/w WBC count over 20,000 (sometimes >100,000)
|
CLL
|
|
|
how can CLL be confirmed
|
flow cytometry
|
|
|
what is richter phenomenon
|
conversion of CLL into high grade lymphoma
|
|
|
Stages of CLL
|
0=increased WBC
1=lymphadenopathy 2=hepatosplenomegaly 3=anemia 4=thrombocytopenia |
|
|
Rx for CLL
|
stage 2-4 fludarabine or rituximab
|
|
|
Rx for refractory cases of CLL
|
cyclophosphamide
|
|
|
Rx for severe infection in CLL
|
IVIG
|
|
|
Rx for autoimmune thrombocytopenia or hemolysis in CLL
|
prednisone
|
|
|
Rx for CLL with just high cell count
|
chlorambucil
|
|
|
hairy cell leukemia is also known as
|
leukemia reticuloendotheliosis
|
|
|
most accurate test for hairy cell leukemia
|
TRAP or CD11c
|
|
|
Rx for hairy cell leukemia
|
cladribine
|
|
|
presentation of hairy cell leukemia
|
pancytopenia
splenomegaly dry, fibrotic, hypercellular BM |
|
|
what should CLL px be prophylaxed for
|
PCP
|
|
|
what is non hodgkins lymphoma
|
proliferation of lymphocytes in the lymph nodes and spleen
|
|
|
how does non hodgkiins present
|
painless lymphadenopathy (not warm/red/tender)
fever night sweats weight loss |
|
|
best initial test for non hodgkins
|
excisional biopsy
|
|
|
what correlates with a worse prognosis in nonhogkins
|
high LDH
|
|
|
mutation in follicular small cell lymphoma
|
14:18
|
|
|
mutation in burkitts
|
8:14
|
|
|
how is nonhodgkins staged
|
BM biopsy
CT scan of chest, abdomen and pelvis |
|
|
staging of non hodgkins lymphoma
|
1=lymph
2=2 or more lymphs 3=both sides of diaphragm 4=widespread |
|
|
Rx for nonhodgkins
|
1-2=local radiation
3-4=chemo + rituximab + CHOP cyclophosphamide, adriamycin, vincristine, prednisone |
|
|
Rx for MALT
|
eradicate H pylori
if not, Bleomycin + CHOP cyclophosphamide, adriamycin, vincristine, prednisone |
|
|
MCC of hodgkins lymphoma
|
nodular sclerosing
|
|
|
presentation of hodgkins lymphoma
|
painless cervical or supraclavicular lymphadenopathy
reed sternberg cells |
|
|
Rx for hodgkins lymphoma
|
1 and 2 = local radiation or chemo
3 and 4 or anyone with B symptoms = ABVD -adriamycin (doxorubicin) -bleomycin -vinblastine -dacarbazine |
|
|
Rx for hodgkins if relapse after radiation
|
chemo
|
|
|
Rx for hodgkins if relapse after radiation and chemo
|
extra high chemo with BMT
|
|
|
complications of radiation therapy
|
increased risk for solid cancer and premature CAD
|
|
|
what test should be done to determine dosing of chemotherapy in hodgkins
|
MUGA or nuclear ventriculogram
|
|
|
SE of vincristine
|
neuropathy
|
|
|
SE of cisplatin
|
renal and ototoxicity
|
|
|
Presentation of mononucleosis
|
posterior cervical lymphadenopathy
palatal patechiae splenomegaly |
|
|
why cant px with mononucleosis play sports and when can they start
|
splenomegaly
they can start when PE is normal (usually 1-3 months) |
|
|
MC presentation of MM
|
bone pain
|
|
|
what causes the hypercalcemia in MM
|
osteoclast activating factor
|
|
|
what causes the bone lysis in MM
|
plasmocyte released humoral factors and expanding plasma cell mass
|
|
|
MCC of death in MM px
|
renal failure and infection
|
|
|
best initial test for MM
|
x ray
|
|
|
what is seen on x ray of MM
|
lytic lesions
|
|
|
why does MM have a decreased anion gap
|
MM has increased amounts of IgG which is cationic
cationic substances increase chloride and bicarbonate levels, which decreased anion gap |
|
|
why does MM cause rouleaux formation
|
IgG paraprotein sticks to RBC
|
|
|
what are bence jones proteins
|
K/y light chains
|
|
|
most specific test for MM
|
BM biopsy that shows more than 10% plasma cells
|
|
|
what is seen on bone scan in MM
|
nothing, lesions are only seen on x ray
|
|
|
what is needed to see bence jones proteins
|
immunoelectrophoresis (UPEP/SPEP)
urine dipstick will not show anything |
|
|
best initial Rx for MM
|
dexamethasone with lenalidomide or bortezomib
|
|
|
what is used to Rx MM in older px who cannot tolerate SE
|
melphalan
|
|
|
most effective Rx for MM
|
BM and Stem cell Transplant if under 70
|
|
|
what is the M spike in MM
|
IgG or IgA
|
|
|
Dx
px with IgG or IgA spike that BM biopsy does not show MM |
MGUS
|
|
|
what is the immunoglobulin spike in waldenstrom macroglobulinemia
|
IgM
|
|
|
presentation of waldenstrom
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hyperviscosity
blurry vision (engorged vessels in eye) vertigo mucosal bleeding reynauds phenomenon |
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best initial therapy for waldestrom
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plasmaphoresis
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what levels are altered when there is a platelet problem
|
BT
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what levels are altered when there is a clotting problem
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clotting factors
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features of platelet bleeding
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patechiae/purpura
mucosal bleeding epistaxis |
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features of factor bleeding
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joints and muscles
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features of idiopathic thrombocytopenia purpura
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platelets <50,000
isolated thrombocytopenia normal sized spleen |
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when is a bleeding in idiopathic thrombocytopenia purpura considered severe
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intracranial bleeding or GI bleeding
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Rx for idiopathic thrombocytopenia purpura when no bleeding or platelets are >30,000
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none
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Rx for idiopathic thrombocytopenia purpura when mild bleeding or platelets <30,000
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steroids
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Rx for idiopathic thrombocytopenia purpura when severe bleeding or platelets <10,000
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IVIG
anti Riho (anti D) (RhoGAM) |
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Rx for idiopathic thrombocytopenia purpura when recurrent episodes or steroid dependent
|
splenectomy
|
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Rx for idiopathic thrombocytopenia purpura when splenectomy or steroids are not effective
|
rituximab
azathioprine cyclosporine mycophenolate romiplostim eltrombopag |
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what vaccines need to be given before splenectomy is performed
|
neisseria
h influ pneumococcus |
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what can worsen vW disease
|
aspirin use
|
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how does vW disease present
|
platelet def. type of bleeding with normal platelet count
|
|
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how can vW disease be diagnosed
|
increased BT
vWF is decreased ristocetin cofactor asay |
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best initial therapy for vW disease
|
desmopressin
|
|
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Rx for vW if no response to desmopressin
|
replace factor 8 or vWF
|
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what happens if recurrent bouts of hemarthrosis
|
hemophilic arthropathy
iron deposition with synovial thickening and fibrosis |
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|
most accurate test for hemophilia
|
specific assay for factor 8 and 9
|
|
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Rx for hemophilia
|
desmopressing
severe cases need to replace specific factors |
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best initial test for hemophilia
|
mixing studies with normal plasma will correct the PTT
|
|
|
Rx for factor 11 def
|
FFP
|
|
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lab findings in DIC
|
elevated PT, PTT, d-dimers, fibrin split products
low platelets and fibrinogen |
|
|
what is seen on blood smear in DIC
|
helmet cells
|
|
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Rx for DIC
|
replaced platelets if under 50,000
replace clotting factors with FFP |
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what is used to Rx DIC if FFP doesnt work
|
cryoprecipitate
|
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Dx
px starts warfarin and develops skin necrosis |
congenital protein C def
|
|
|
MCC of hypercoagulable state
|
factor 5 leiden mutation
|
|
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how can HIT be confirmed
|
ELISA for PF4 antibodies
or serotonin release assay |
|
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Rx for HIT
|
stop all heparin
switch to argatroban, lepirudin, danaparoid and bivalirudin finally get px on warfarin after switching |
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Rx for severe cases of HIT
|
plasmaphoresis
|
|
|
best initial test to Dx antiphospholipid syndrome
|
mixing study (will not correct PTT)
|
|
|
most accurate test for antiphospholipid syndrome
|
russel viper venom test
|
|
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Rx for antiphospholipid syndrome
|
herparin and warfarin
|
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next step in a px who is pregnant, has already had a miscarriage and is currently pregnant
|
begin heparin to protect current pregnancy
|
|
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Rx if px develops hypocalcemia after a transfusion
|
calcium gluconate
|
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|
Dx
elderly px develops brownish discoloration after minor trauma |
senile purpura
|
|
|
pathophys behind seniles purpura
|
perivascular connective tissue atrophy with hemosiderin deposits
|
