Purpura Fulminans Workup

Updated: Jan 04, 2018
  • Author: Marten Basta, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Workup

Laboratory Studies

Once purpura fulminans is suspected, workup should begin immediately to identify the underlying etiology. Laboratory studies are the primary diagnostic tools for working up purpura fulminans and should include the following:

  • Complete blood count (CBC) with differential
  • Basic metabolic panel
  • Liver function tests
  • Prothrombin time, international normalized ratio, and activated partial thromboplastin time
  • Fibrinogen, D-dimer levels
  • Blood cultures
  • Qualitative/quantitative coagulation cascade protein assays

Abnormalities in the CBC and coagulation cascade indicate DIC, as highlighted in the table below.

Table 1. (Open Table in a new window)

Typical Lab Values in Acute Disseminated Intravascular Coagulopathy (DIC)*

Lab Test

Acute DIC

Reference Range

Platelet count

<150,000/L

150,000-450,000/L

Fibrinogen

>340 mg/dL

170-340 mg/dL

Prothrombin time (PT)

>13 seconds

9-13 seconds

Activated partial thromboplastin time (aPTT)

>35 seconds

23-35 seconds

D-dimer

>250 ng/mL

0-250 ng/mL

*Table created using data from: Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009 Apr;145(1):24-33.

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Histologic Findings

A peripheral blood smear may indicate microangiopathic hemolytic anemia (MAHA) with schistocytes, bite cells, and helmet cells. (See the image below.)

Schistocytes (arrows) on a peripheral smear. Court Schistocytes (arrows) on a peripheral smear. Courtesy of Bodhit AN, Stead LG. Altered mental status and a not-so-benign rash. Case Rep Emerg Med. 2011;2011:684572.
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