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Blood Vessel Abnormalities

When blood vessels become weakened, bleeding occurs more easily. Vessels may be weakened by
inflammation, malformation, or disease of the blood vessel’s supportive tissue. The following are
examples of conditions that may cause bleeding.

Scurvy

Scurvy is a deficiency in vitamin C, usually due to poor diet. Vitamin C is necessary in forming the blood
vessel’s chief supportive tissue, collagen. Therefore, without sufficient vitamin C, the blood vessels are
weakened, and bleeding occurs more easily. Symptoms of scurvy include bleeding of the gums and
bruising. Scurvy is most often caused by insufficient vitamin C in the diet, although it may also be the
result of megaloblastic anemia. Depending on the cause, vitamin C supplements are administered or the
anemia is treated (please see Anemia).

Henoch-Schönlein Disease (Anaphylactoid or Allergic Purpura)

Henoch-Schönlein purpura, or HSP, is an inflammation of blood vessel walls (aseptic vasculitis). It is

associated with joint pain, abdominal symptoms, and kidney involvement. Its chief symptom is purpura,
a pinkish to reddish-brown raised spot on the skin which begins with an itching feeling. HSP occurs most
often in children, who usually notice joint and abdominal pain before purpura form. However, in adults,
purpura is usually the first symptom. The characteristic purpura is painless and often occurs on the
arms, legs, and buttocks. Other symptoms include bruising, abdominal pain, apathy, headache, seizures,
blood in the stool, and arthritic pain in the joints. HSP may be triggered by infection (hepatitis B; ß-
hemolytic Streptococcus, or “strep throat”; cytomegalovirus; Epstein-Barr virus), medications (penicillin,
sulfa drugs such as Bactrim, phenytoin [Dilantin], iodine, drugs such as cimetidine and Tagamet,
allopurinals such as Zyloprim), certain chemicals or insecticides, systemic autoimmune diseases such as
rheumatoid arthritis and systemic lupus erythematosus (discussed below), cancer, and food products
(dyes, preservatives). Treatment focuses on minimizing bleeding and may involve administration of
steroids. The disorder usually ends on its own after 4 to 6 weeks, although relapses are common.

Systemic Lupus Erythematosus (SLE)

SLE is a systemic autoimmune disease that may affect blood vessel connective tissue, producing
inflammation of the blood vessel wall. In addition to increased bleeding, other SLE symptoms may be
present. These include sensitivity to light, mouth sores, arthritis, seizures, anemia, skin rashes,
nosebleed, and abdominal pain. It is diagnosed by patient history, physical examination for symptoms,
and laboratory testing. Treatment should target the underlying disease. Possible options for treatment
are plasmapheresis and medications such as corticosteroids such as Celestone, Betamethasone, Cortone
and Cortisone, cyclophosphamide and azathioprine. It is often suggested that patients avoid aspirin,
since it may lead to increased bleeding. Other connective tissue diseases, such as rheumatoid arthritis,
may result in a similar condition. More information on systemic lupus erythematosus.
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Other Factors

In addition to these disorders, factors that may cause bleeding and bruising include infection,
corticosteroid therapy, and Cushing’s syndrome. Senile purpura is another condition with bleeding
symptoms. It primarily affects elderly patients, and its symptoms are easy bruising, bleeding, and red
spots on the skin (purpura).