Hi sauna_sue,
Before I begin my answer, I need to remind you that this answer is
for informational purposes only, and not intended to diagnose your
problem, or to replace sound medical advice from a licensed physician.
Your private physician is the best source of information pertaining to
this problem, and s/he is aware of your complete medical history.
Having said that, I have included in my response several ?could be?
answers. Some may seem more relevant than others to you, as you know
your symptoms and medical history in depth. Be aware that
conditions/disorders/syndromes can manifest themselves differently in
different patients. What Patient A presents with may not be what
Patient B presents with, due to medications, hereditary, age,
lifestyle, etc. Also, some of the possibilities I have included are
more serious than others, and are mentioned here, not to alarm you,
but to inform you. It appears from your picture that you may have some
varicose veins (or it may be a shadow from the hose ridges). If so,
your leg vessels may be fragile, with poor circulation, so that when
you stand or walk a lot, the pressure, along with the swelling of the
edema, forces the blood out of your vessels, into the skin.
Your doctor is referring you to a hematologist because s/he may
suspect a clotting disorder, coagulopathy, vasculopathy, or a
thrombocytopenia (decreased platelet count). These disorders are
complicated matters that can stem from something as seemingly
innocuous as an over the counter anti-inflammatory (Ibuprofen) or
something more serious such as an autoimmune disease, leukemia or
malignancy.
You state you don?t feel this is a life threatening problem. While it
may not be an immediate problem,(you say you have had this for some
time) I do feel you need medical attention soon. You ?could? try
eliminating the Mobic for a time and see if the edema improves, but I
feel you should seek prompt medical attention, at least for initial
blood tests. Has your doctor reviewed ALL medications as well as any
vitamins and supplements you may be taking? Has your physician run any
blood tests? If not, s/he can order the same tests as a hematologist
would, thus avoiding a specialist visit should the tests come back
negative. I think you will need to get at the root of the edema as
well!
http://www.fpnotebook.com/REN15.htm
http://www.footsmart.com/Leg-Circulation-Leg-Edema.aspx
http://health.allrefer.com/health/peripheral-edema-lower-leg-edema.html
http://patients.uptodate.com/topic.asp?file=kidn_dis/4639
Your hematologist (or primary doctor) will likely order screening
tests to begin diagnosing the cause of your red legs. Common tests for
bleeding/clotting disorders include a CBC- Complete Blood Count (which
includes counts of your red and white blood cells, and platelets), a
Pro Time (Prothrombin time), a PTT (Partial Thromboplastin time) and
liver enzymes. Some hematologists still like some of the old clotting
tests that involve pricking your earlobe and timing how long it takes
to form a solid clot. Should any of these tests indicate an
abnormality, your hematologist may then order a bone marrow test. A
bone marrow sample can show how immature red and white blood cells are
forming, as well as detect any platelet disorders and malignancies
such as leukemias.
The simplest and possibly most obvious cause of your ?red legs? would
be medications. It may be that your medications are triggering the
formation of your red blotches:
Mobic (meloxicam) belongs to the enolic acid group of nonsteroidal
anti-inflammatory drugs (NSAIDs): One of the side effects of Mobic is
fluid retention (edema), and patients that have a bleeding or
clotting disorder should not take Mobic. Both Mobic and Zetia can
cause liver problems, which can be detected early by having blood
drawn for liver enzymes. Liver problems can also lead to clotting
disorders. Lipitor can cause peripheral edema.
http://www.drugs.com/mobic.html
http://www.fda.gov/cder/consumerinfo/druginfo/mobic.htm
http://www.drugs.com/zetia.html
http://www.rxlist.com/cgi/generic/ezetimibe_ad.htm
http://www.rxlist.com/cgi/generic/atorvastatin_ad.htm
Peripheral Edema
?Painless swelling of the feet and ankles is a common problem,
particularly in older people. It may affect both legs and may include
the calves or even the thighs. Because of the effect of gravity,
swelling is particularly noticeable in the lower legs.
When squeezed, the fluid will move out of the affected area and may
leave a deep impression for a few moments.
Swelling of the legs is many times related to systemic causes (for
example, heart failure, renal failure, or liver failure).?
http://health.yahoo.com/health/ency/adam/003104
http://www.umm.edu/ency/article/003104.htm
Petechiae
Petechiae are red blotches, usually small, on the skin.
?There are many possible causes of petechiae. Common causes include:
· injury or trauma
· allergic reactions to medications
· autoimmune disorders, which are conditions in which the person's
body creates antibodies to its own tissues for unknown reasons
· liver disorders, such as cirrhosis
· infections, such as mononucleosis and endocarditis
· bone marrow disorders, such as leukemia
· thrombocytopenia, a deficiency of platelets
· nutritional deficiencies, such as a deficiency in vitamins C, K, or
B12, or folic acid · medications, such as blood thinners
· recent blood transfusions
· medical treatment, such as radiation therapy and chemotherapy for cancer
· birth, due to the pressure changes caused by vaginal delivery
· aging skin
· sepsis, or blood infection
· violent vomiting or coughing.?
http://health.discovery.com/encyclopedias/972.html
DVT
Deep Vein Thrombosis is usually seen in one leg only, though it can
occur in both, and is not common in people who exercise regularly.
?Deep vein thrombosis, commonly referred to as DVT, is a disease of
the circulation. It occurs most often in people who have not been able
to exercise normally.
Blood passing through the deepest veins in the calf or thigh flows
relatively slowly: when a DVT occurs it moves so slowly that it forms
a solid clot which becomes wedged in the vein.?
http://www.fpnotebook.com/HEM29.htm
http://news.bbc.co.uk/1/hi/health/medical_notes/c-d/986364.stm
http://www.medicinenet.com/deep_vein_thrombosis/article.htm
Chronic Venous Insufficiency
?Chronic venous insufficiency (CVI) occurs when damaged vein valves or
a DVT causes long-term pooling of blood and swelling in the legs. If
uncontrolled, fluid will leak into the surrounding tissues in the
ankles and feet, and may eventually cause skin breakdown and
ulceration?
http://www.clevelandclinic.org/heartcenter/pub/guide/disease/vascular/whatis.htm
http://www.emedicine.com/med/topic2760.htm
Here are some photos of patients with CVI. Warning: Some images are
very graphic, and it is apparent these patients are in far worse
condition than are you! This is a slide show - simply click the arrows
to advance the pictures.
http://medicine.ucsd.edu/clinicalimg/extremities-venous-insuf4.html
Stasis dermatitis
·?Swelling of legs, ankles, or other areas
·Skin appears thin, tissue-like
·Skin lesion: macule or patch
·Skin spots, red
·Darkening of skin at the ankles or legs
·Thickening of skin at the ankles or legs
·Open sores, ulcers (may develop)
·Superficial skin irritation of the legs
·Itching (of the affected area)
·Leg pains (in the affected area)?
http://www.nlm.nih.gov/medlineplus/ency/article/000834.htm
http://www.healthcentral.com/mhc/img/img2136.cfm
Lymphedema
?Primary lymphedema, which can affect from one to as many as four
limbs and/or other parts of the body, can be present at birth, develop
at the onset of puberty (praecox) or in adulthood (tarda), all from
unknown causes, or associated with vascular anomolies such as
hemangioma, lymphangioma, Port Wine Stain, Klippel Trenaury.
Secondary lymphedema, or acquired lymphedema, can develop as a result
of surgery, radiation, infection or trauma. Specific surgeries, such
as surgery for melanoma or breast, gynecological, head and neck,
prostate or testicular, bladder or colon cancer, all of which
currently require removal of lymph nodes, put patients at risk of
developing secondary lymphedema. If lymph nodes are removed, there is
always a risk of developing lymphedema.
Secondary lymphedema can develop immediately post-operatively, or
weeks, months, even years later. It can also develop when chemotherapy
is unwisely administered to the already affected area (the side on
which the surgery was performed) or after repeated aspirations of a
seroma (a pocket of fluid which occurs commonly post-operatively) in
the axilla, around the breast incision, or groin area. This often
causes infection and, subsequently, lymphedema.?
http://www.lymphnet.org/whatis.html
http://www.cancer.org/docroot/MIT/content/MIT_7_2x_Understanding_Lymphedema.asp?sitearea=MIT&viewmode=print&
Purpuras
What you have is probably NOT Henoch-Schönlein purpura, but here is
some information to read over. Yours may fall into another purpura
category however. Purpuric areas with H-S turn red to purple, then
rust colored, light brown, and fade away. H-S purpura usually occurs
in the age range of 2-11 years of age. The disorder almost always
presents with a classic triad of gastrointestinal upsets, with
hematuria (blood in the urine) and arthritis.
http://www.aafp.org/afp/980800ap/kraft.html
?Purpura is sudden, severe, bruising that may be localized, regional,
or widespread, and occurs without an injury. People who develop
purpura often have signs of illness, such as a fever, weakness,
fatigue, or a vague sense of being ill (malaise). The bruising caused
by purpura is different from the isolated bruises a person often gets
after bumping into an object or falling.
A bleeding or clotting disorder is the most common cause of purpura.
Purpura that comes on quickly over a short period (a few hours) may be
a sign of a serious infection that requires immediate medical
treatment.?
http://www.questdiagnostics.com/kbase/topic/symptom/bruse/overview.htm
Vascular purpura
?Hypergammaglobulinemic purpura is a syndrome that primarily affects
women. It is characterized by a polyclonal increase in IgG
(broad-based or diffuse hypergammaglobulinemia on serum protein
electrophoresis) and recurrent crops of small, palpable purpuric
lesions on the lower legs. These lesions leave small residual brown
spots. Vasculitis is seen on biopsy. Many patients have manifestations
of an underlying immunologic disorder (eg, Sjögren's syndrome, SLE).?
http://www.merck.com/mrkshared/mmanual/section11/chapter134/134f.jsp
Schamberg's purpura
Schamberg's disease (progressive pigmented purpura). ?The capillaries
are small blood vessels near to the skin surface. For unknown reasons
they sometimes become inflamed. Blood cells may pass through small
gaps that arise between the cells, which make up the capillary walls.
The result is tiny red dots appear on the skin, described as cayenne
pepper spots. They group together to form a flat red patch, which
becomes brown and then slowly fades away over weeks to months.?
This is the most common type of capillaritis. Crops of red-brown flat
patches with cayenne pepper spots on their borders appear for no
apparent reason. Although most common on the lower legs, Schamberg's
can arise on any part of the body. It is usually irregularly
distributed on both sides with few or many patches. There are no
symptoms.?
http://dermnetnz.org/vascular/capillaritis.html
http://www.dermnet.com/thumbnailIndex.cfm?moduleID=22&moduleGroupID=322&groupIndex=0&numcols=0
Purpura Fulminans
http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=-215061246
http://tjp.dergisi.org/pdf//xml/pdf-44.pdf
ITP - Idiopathic Thrombocytopenic Purpura
?ITP, idiopathic thrombocytopenic purpura, also known as immune
thrombocytopenic purpura, is classified as an autoimmune disease. In
an autoimmune disease the body mounts an attack toward one or more
otherwise normal organ systems. In ITP, platelets are the target.
They are marked as foreign by the immune system and eliminated in the
spleen, or sometimes the liver.?
http://www.itppeople.com/aboutitp.htm
?ITP can present itself with small purple spots called petechiae in
the mouth and legs, nose bleeds, and bleeding gums during normal
dental care. Some people develop bruises on their arms and legs with
no provocation. It is often accompanied by fatigue and sometimes
depression.?
http://www.itppeople.com/moreabou.htm
http://www.netdoctor.co.uk/diseases/facts/itp.htm
http://www.vh.org/adult/patient/cancercenter/blooddisorders/essentialthrombo.html
?The disorders most commonly confused with chronic ITP are as follows:
· Drugs. Certain drugs cause low platelet counts. The most common are
quinine, quinidine, sulfa and sulfa-like drugs and heparin. However,
many other drugs have caused thrombocytopenia in occasional patients.
If the patient is taking a potentially causitive drug, it should be
stopped and the platelet count observed. If a drug is the cause, the
platelet count will become normal within 2-3 weeks, although there are
occasional exceptions (e.g., thrombocytopenia due to gold therapy in
patients with rheumatoid arthritis).
· Immune thrombocytopenia associated with other diseases.
Thrombocytopenia may be associated with a variety of diseases
including: collagen vascular disease (such as systemic lupus
erythematosus), lymphoproliferative disorders (such as chronic
lymphocytic leukemia or non-Hodgkin's lymphoma), and infections
(particularly viral infections such as HIV, cytomegalovirus, hepatitis
and mononucleosis). These disorders can be ruled out by careful
examination and the appropriate laboratory studies.
· Disorders associated with decreased platelet production. A variety
of diseases such as aplastic anemia, acute leukemia, etc. can cause
thrombocytopenia. These can be easily ruled out by evaluation of the
blood count and bone marrow.?
http://seconde.scripps.edu/itp/dxprog.html
Leukocytoclastic Vasculitis
?A necrotizing vasculitis accompanied by extravasation and
fragmentation of granulocytes.
Causes include hypersensitivity to drugs, viral infections (eg,
hepatitis), and collagen vascular disorders. The most common clinical
manifestation is palpable purpura, often associated with systemic
symptoms, such as polyarthralgia and fever. Diagnosis is established
by skin biopsy. Therapy is determined by the underlying cause of the
vasculitis.?
http://www.merck.com/mrkshared/mmanual/section11/chapter134/134g.jsp
Thrombocytopenia
Platelets originate from stem cells in the bone marrow, are
irregularly shaped, and help blood clot after a wound. In
thrombocytopenias the body may not produce enough platelets, they may
get destroyed by a drug or disease process, or they may be defective
and not function. Too few platelets can cause petechiae and red
blotches from capillary blood that has escaped into the skin.
http://sln.fi.edu/biosci/blood/platelet.html
http://www.netdoctor.co.uk/diseases/facts/thrombocytopenia.htm
http://www.fpnotebook.com/HEM197.htm
Platelet Dysfunctions
?In some disorders, the platelets may be normal in number, yet
hemostatic plugs do not form normally and the bleeding time will be
long. Platelet dysfunction may stem from an intrinsic platelet defect
or from an extrinsic factor that alters the function of otherwise
normal platelets. Defects may be hereditary or acquired. Tests of the
coagulation phase of hemostasis (eg, partial thromboplastin time and
prothrombin time) are normal in most circumstances but not all?
http://www.merck.com/mrkshared/mmanual/section11/chapter133/133c.jsp
http://www.fpnotebook.com/HEM193.htm
PVD and PAD
Peripheral Vascular Disease and Peripheral Arterial Disease
?What are the symptoms of PAD?
The earliest and most common symptom of peripheral arterial disease is
intermittent claudication, a tightness or squeezing pain in the calf,
thigh, or buttock during exertion, such as walking. The pain is
usually triggered at a certain point after the same amount of exercise
and is relieved by rest. As the condition worsens, foot and toe pain
may occur at rest. Some people may not have any symptoms until
complications develop.?
http://www.peacehealth.org/kbase/topic/special/aa105361/sec1.htm
http://www.veins1.com/care/condition20.cfm?BulletinID=38
http://www.americanheart.org/presenter.jhtml?identifier=3020252
http://www.clevelandclinicmeded.com/diseasemanagement/cardiology/pad/pad.htm
Other photos:
Purpura
http://bmc.ub.uni-potsdam.de/1471-5945-2-1/F1.htm
About compression hose (TED hose)
Be sure and put on your hose when you wake, and not after you have
been up. If you have been up and walking around, you will need to lie
down, with your feet elevated for 20-30 minutes before putting on your
hose.
http://www.supporthosiery.com/compression_hosiery.htm
http://www.theeagle.com/healthpro/woundcare/
http://www.insideairports.com/traveltips/dvt.asp
Finally, sauna_sue, don?t smoke, and have your blood pressure
checked, as many circulatory problems can be caused and/or aggravated
by high blood pressure and the use of tobacco products. Please visit
your doctor and consider a hematological consult as well. I wish you
all the best!
Thank you for posting the picture of your leg, and thanks to
tlspiegel-ga for suggesting it!
If any part of my answer is unclear, I will be happy to assist you
further, if you request an Answer Clarification, before rating.
Regards, crabcakes
Search Terms
Petechiae
Chronic Venous Insufficiency
Thrombocytopenia
Coagulopathies
PAD
peripheral arterial disease
PVD
Peripheral edema
Small Vessel Vasculitis
hemagiomas |
