Henoch-Schonlein Purpura in Emergency Medicine Workup

  • Author: Philip Bossart, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Apr 15, 2010
 

Laboratory Studies

  • Diagnosis of Henoch-Schönlein purpura is clinical and not based on laboratory evaluation. Routine laboratory test results are usually within reference ranges.
  • Some laboratory studies help in excluding other diagnoses and in evaluating renal function, including urinalysis, CBC with platelet count and differential, BUN level, creatinine level, prothrombin time (PT), activated partial thromboplastin time (aPTT), and lipase level.
  • Urinalysis: Hematuria and/or proteinuria are present in 10-20% of patients.
  • Platelet count and coagulation studies: Platelet count is usually in the reference range but may be elevated; the platelet count should not be low in Henoch-Schönlein purpura. A normal platelet count rules out idiopathic thrombocytopenic purpura (ITP). A normal platelet count and normal coagulation studies (ie, PT, aPTT, fibrin split products) rule out thrombotic thrombocytopenic purpura (TTP).
  • Lipase: A normal lipase level makes acute pancreatitis very unlikely.
  • CBC and differential: WBC count may be in the reference range or elevated. Eosinophilia is sometimes present.
  • Erythrocyte sedimentation rate: Sedimentation rate may be in the reference range or elevated.
  • BUN and creatinine levels: These may be elevated from renal involvement of Henoch-Schönlein purpura (HSP) or from dehydration.
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Imaging Studies

  • Abdominal ultrasonography may be better than barium enema to diagnose intussusception, since Henoch-Schönlein purpura (HSP)–related intussusception is more often ileoileal instead of ileocolic as is typical in idiopathic intussusception.
  • Doppler or radionuclide testicular scan results show normal or increased blood flow in Henoch-Schönlein purpura, in contrast to the decreased blood flow seen in testicular torsion.
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Contributor Information and Disclosures
Author

Philip Bossart, MD  Professor, Department of Surgery, Division of Emergency Medicine, University of Utah Hospital, University of Utah School of Medicine

Philip Bossart, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Edmond A Hooker II, MD, DrPH, FAAEM  Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  2. Szer IS. Henoch-Schonlein purpura. Curr Opin Rheumatol. Jan 1994;6(1):25-31. [Medline].

  3. Gedalia A. Henoch-Schonlein purpura. Curr Rheumatol Rep. Jun 2004;6(3):195-202. [Medline].

  4. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol. May 2002;13(5):1271-8. [Medline].

  5. O'Brien WM, O'Connor KP, Horan JJ, Eggli DF, Gibbons MD. Acute scrotal swelling in Henoch-Schonlein syndrome: evaluation with testicular scanning. Urology. Apr 1993;41(4):366-8. [Medline].

  6. Bogdanovic R. Henoch-Schonlein purpura nephritis in children: risk factors, prevention and treatment. Acta Paediatr. Dec 2009;98(12):1882-9. [Medline].

  7. Chartapisak W, Opastirakul S, Hodson EM, Willis NS, Craig JC. Interventions for preventing and treating kidney disease in Henoch-Schonlein Purpura (HSP). Cochrane Database Syst Rev. Jul 8 2009;CD005128. [Medline].

  8. [Best Evidence] Chartapisak W, Opastiraku S, Willis NS, Craig JC, Hodson EM. Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review. Arch Dis Child. Feb 2009;94(2):132-7. [Medline].

  9. Saulsbury FT. Clinical update: Henoch-Schonlein purpura. Lancet. Mar 24 2007;369(9566):976-8. [Medline].

  10. Huber AM, King J, McLaine P, Klassen T, Pothos M. A randomized, placebo-controlled trial of prednisone in early Henoch Schonlein Purpura [ISRCTN85109383]. BMC Med. Apr 2 2004;2:7. [Medline].

  11. [Best Evidence] Ronkainen J, Koskimies O, Ala-Houhala M, et al. Early prednisone therapy in Henoch-Schonlein purpura: a randomized, double-blind, placebo-controlled trial. J Pediatr. Aug 2006;149(2):241-7. [Medline].

  12. Flynn JT, Smoyer WE, Bunchman TE, Kershaw DB, Sedman AB. Treatment of Henoch-Schonlein Purpura glomerulonephritis in children with high-dose corticosteroids plus oral cyclophosphamide. Am J Nephrol. Mar-Apr 2001;21(2):128-33. [Medline].

  13. Szer IS. Henoch-Schonlein purpura: when and how to treat. J Rheumatol. Sep 1996;23(9):1661-5. [Medline].

  14. [Best Evidence] Weiss PF, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of corticosteroid on Henoch-Schonlein purpura: a systematic review. Pediatrics. Nov 2007;120(5):1079-87. [Medline].

 
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Typical rash distribution of Henoch-Schönlein purpura.
Characteristic rash of Henoch-Schönlein purpura.
 
 
 
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