Angiopathies - Practical hematology of children's age

Chapter VII
HEMORRHAGIC DIATHESIS
ANGIOPATHIES
Hemorrhagic angiopathies are a group of diseases which cornerstone defeat of a vascular link of system of a hemostasis is that causes the raised bleeding. The etiology and a pathogeny of hemorrhagic angiopathies are various, they can be as a separate nosological form, and to represent a hemorrhagic syndrome of a basic disease. Classification and the nomenclature of hemorrhagic syndromes of a vascular origin remain a controversial issue so far. However the group of angiopathies on etiological and pathogenetic signs has great practical value as arms the doctor with understanding of essence of hemorrhagic manifestations and the corresponding approaches to therapy.
Allocate several main groups of hemorrhagic angiopathies (V. A. Germanov, 1979).

1. Immunocomplex hemorrhagic angiopathies which cornerstone damage of a vascular wall by a cell-bound immune complex antigen — an antibody is. The hemorrhagic vasculitis as an independent nosological form belongs to this group of diseases. Immunocomplex hemorrhagic angiopathies as a syndrome are observed at many immunopathological processes, in particular collagenoses, infektsionnoallergichesky diseases, etc.
2. Infectious hemorrhagic angiopathies are complications of heavy infectious process. They are observed at a meningokokktsemiya, viral diseases (measles, a rubella, flu), viral hemorrhagic fevers, a hay fever, sapropyra, especially dangerous infections (natural smallpox, plague).
3. Metaplastic hemorrhagic angiopathies which cornerstone tumoral defeat of a vascular wall is. They are observed at different malignant oncological diseases. In many cases the hemorrhagic syndrome is combined on the genesis when there is a defeat not only vessels, but also a platelet link of system of a hemostasis.
4. Dysplastic hemorrhagic angiopathies are the hereditary or inborn diseases caused by maldevelopment of connecting fabric. They represent the hemangiomas having the different sizes and localization. Formation of macrohemangiomas, and also their localization in vitals constitutes serious danger and a possibility of a lethal outcome. Feature of hemorrhagic angiopathies is the raised bleeding from defective places and development of posthemorrhagic anemia, sometimes heavy degree. Bleedings arise spontaneously at inadequate influence. Treat group of dysplastic hemorrhagic angiopathies: an illness of Randyu — Oslera, Kazabakh's syndromes — Merritt, Elers — Danlosa, Louis Bar, Gippel — Lindau, etc.
5. Dystrophic hemorrhagic angiopathies at which functional disturbances of a vascular wall are caused by disturbance of food of cells and fabrics — cellular dystrophy. They arise at hypo - and avitaminosis (deficit of ascorbic acid and vitamin P), endocrinopathies, beam impact on an organism, aging of fabrics and vessels. Dystrophic hemorrhagic angiopathies are the syndrome of a basic disease complicating its current. Dystrophic changes of vessels are characteristic of exogenous and endogenous insufficiency of ascorbic acid, the shown bleeding of gums and hemorrhages on skin and in gastrocnemius muscles.
6. Neuropathic hemorrhagic angiopathies which description belongs to Middle Ages times. In the history of religion there were certificates on persons who in religious ecstasy cried bloody tears. In modern literature a number of hemorrhagic manifestations of neurogenic character is described; as a rule, they are marked out at persons with the changed psychoemotional status though can be observed at almost healthy people in the mental relation during the periods of the raised emotional loading.

It is noted that much not true neuropathic hemorrhagic angiopathies, and imitation, simulation of a hemorrhagic syndrome meet more often (3. S. Barkagan, 1980). Such situations occur at children considerably less than at adults.