Angina Bullosa Hemorrhagica Workup

Updated: Dec 15, 2017
  • Author: Kara Melissa T Torres, MD, DPDS; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

In angina bullosa hemorrhagica (ABH), platelet counts and coagulation tests are within normal limits.

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Procedures

Performing a biopsy of an intact bulla is difficult because of the short duration of the lesion.

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Histologic Findings

The diagnosis of angina bullosa hemorrhagica (ABH) essentially is clinical; however, in cases in which biopsies have been performed, microscopic examination reveals a subepithelial bulla containing RBCs and an underlying mild and nonspecific chronic lymphocytic inflammatory cell infiltrate that generally is limited to the region of the lamina propria. The surface epithelium may be intact or show nonspecific ulceration. Fibrinoid material within the blister and/or beneath the basement membrane may also be present. [13] In one report, angina bullosa hemorrhagica was reported to mimic a neutrophil-rich subepithelial blistering disorder. [21]

Performing a biopsy of an intact bulla is difficult because of the short duration the lesion remains intact. Otherwise, a biopsy of a ruptured bulla exhibits a nonspecific ulceration.

Direct immunostaining for immunoglobulin G, immunoglobulin A, immunoglobulin M, and fibrin is usually negative; however, there may be equivocal staining for immunoglobulin G and C3 along the basement membrane zone. [18, 24]

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