Henoch-Schönlein Purpura (HSP)

• Henoch-Schönlein Purpura (HSP) is a systemic vasculitis, primarily affecting small vessels.
• It is characterized by inflammation and damage to these vessels, leading to a variety of clinical manifestations.
• HSP is most common in children, but can occur at any age.

Assessment Findings

• The classic presentation of HSP includes a tetrad of symptoms.
• Rash: The rash is typically a palpable purpura, meaning it can be felt upon palpation.
  • It is non-blanching, indicating that the redness does not disappear when pressed.
  • The rash is often located on the lower extremities (legs and buttocks).
• Arthralgias: Joint pain, or arthralgia, is another common symptom.
  • It usually affects the large joints, such as the knees and ankles.
  • The pain can be mild to severe and may limit mobility.
• Abdominal pain: Abdominal pain is frequently reported in HSP.
  • It can be colicky in nature.
  • In some cases, gastrointestinal bleeding may occur, leading to blood in the stool (hematochezia) or vomit (hematemesis).
• Hematuria: Kidney involvement is a significant feature of HSP.
  • It often results in hematuria, which is the presence of blood in the urine.
  • Proteinuria (protein in the urine) may also be present, indicating kidney damage.

Diagnostic Tests

• A combination of laboratory and imaging studies are used to diagnose and assess the severity of HSP.
• CBC (Complete Blood Count): A CBC is performed to evaluate the number and types of blood cells.
  • In HSP, the platelet count is usually normal, helping to differentiate it from other conditions that cause purpura, such as thrombocytopenic purpura.
• Coags (Coagulation Studies): Coagulation studies assess the blood's ability to clot.
  • They are typically normal in HSP, helping to rule out other bleeding disorders.
• UA (Urinalysis): A urinalysis is crucial for detecting kidney involvement.
  • It can identify hematuria and proteinuria, which are indicative of kidney inflammation.
• U/S (Ultrasound): An abdominal ultrasound may be performed to evaluate the abdominal organs, particularly the kidneys and gastrointestinal tract.
  • It can help identify complications such as bowel wall thickening or intussusception (a condition where one part of the intestine slides into another).

Interventions and Management

• Monitoring vital signs is essential for assessing the patient's overall condition and detecting any signs of instability.
• Accurate recording of input and output (I&Os) is important, especially in patients with kidney involvement.
  • This helps monitor fluid balance and kidney function.
• Hemodialysis: In severe cases of kidney failure, hemodialysis may be necessary.
  • Hemodialysis is a process that removes waste products and excess fluid from the blood when the kidneys are unable to do so.
• Surgery: In rare cases, surgical intervention may be required.
  • For example, if intussusception occurs as a complication of HSP, surgery may be needed to correct the intestinal blockage.