Anemia rash, while not a medical term, can sometimes refer to small red pinpricks on the skin, often on the lower legs. Along with a rash, people may experience bruises and fatigue.

These pinpricks are usually called petechiae or purpura, depending on their size. It is most commonly attributed to a low platelet count in aplastic anemia or with certain infections.

This article explores many reasons for a low platelet count and the accompanying rash.

Some types of anemia can hinder or even stop blood cell production in the bone marrow. Bone marrow is a spongy tissue inside the bones that produces stem cells. These stem cells are red blood cells, white blood cells, and platelets.

Platelets are blood cell fragments that stick together and stop bleeding. When platelet counts are too low, the blood cannot clot normally, and this causes superficial bleeding under the skin.

The most common is aplastic anemia, also known as bone marrow failure. A person can develop or inherit aplastic anemia.

Aplastic anemia occurs when there is a failure in the bone marrow.

Acquired aplastic anemia

Aplastic anemia is a rare, serious blood disorder in which the bone marrow stops producing platelets, red blood cells, and white blood cells. It mainly affects adolescents, young adults, and the elderly.

Bone marrow damage can be temporary or permanent and can occur due to.

This damage can cause aplastic anemia to develop. If the condition’s cause is unknown, it is idiopathic aplastic anemia.

A low platelet count can make a person more susceptible to bruising and cause petechiae.

Inherited aplastic anemia

Several rare, inherited conditions may cause aplastic anemia. The most common of these is Fanconi anemia.

Approximately 90% of people with Fanconi anemia will eventually experience bone marrow failure, which may cause a rash. Aplastic anemia is usually just one of the problems a person affected by Fanconi anemia will experience.

Iron deficiency anemia

Iron deficiency anemia can cause the skin to become itchy (pruritus) and susceptible to bruising. Scratched and bruised skin can cause a rash-like appearance.

As the name implies, iron deficiency anemia occurs when a person has insufficient iron. This may occur due to a poor diet, blood loss, or side effects from medication.

However, unlike aplastic anemia, iron deficiency anemia does not affect platelets in the blood, but rather the production of red blood cells.

A doctor may suspect aplastic anemia if other symptoms of anemia occur along with the rash. A low platelet count that occurs with aplastic anemia may also produce other symptoms, including:

Other symptoms of anemia may include:

Aplastic anemia or bone marrow failure may also contribute to frequent or prolonged infections due to decreased white blood cell count.

A doctor will aim to identify and treat the underlying cause of the anemia rash using medical history, a physical examination, and test results.

Establishing a medical history is important to assess potential causes of bone marrow damage, especially in cases of acquired aplastic anemia. These causes may include any of the following:

  • exposure to toxins, radiation, or harmful environmental agents
  • cancer treatments, such as radiation and chemotherapy
  • a history of certain infectious diseases or autoimmune disorders
  • infections or inherited conditions

A doctor will look for signs of bleeding under the skin and may feel the person’s abdomen to determine whether they have an enlarged spleen. They will also ask about any previous illnesses and want to know about any medications or supplements a person takes.

A complete blood count will determine the number of blood cells, including platelets, in a blood sample. Fewer than 150,000 platelets µL is considered abnormally low. Blood tests can also help rule out other causes of bone marrow failure.

If a doctor suspects aplastic anemia, they will likely refer the person to a hematologist specializing in blood diseases and disorders.

Learn more about platelet count levels here.

Any treatment plan needs to address the underlying cause of the anemia rash and to restore the body’s blood cell production.

Aplastic anemia can be classified as non-severe, severe, or very severe. This is based on a person’s blood count and will help determine the treatment plan. The lower the number of blood cells, the more severe the condition.

Treatment for aplastic anemia may include:

  • blood transfusions
  • blood and marrow stem cell transplants
  • medicines

Medication may be prescribed to achieve the following:

  • stimulate bone marrow
  • suppress the immune system
  • prevent and treat infections

Outlook and recovery depend on the underlying cause of the anemia rash. Underlying damage to the bone marrow may be temporary or permanent.

Aplastic anemia, the most common underlying cause of anemia rash, is rare and serious. It can appear suddenly, or it can develop gradually. If it is left untreated, aplastic anemia may get worse over time.

Most people affected by aplastic anemia can be successfully treated, even in severe cases, although this can take time. Some may even be cured.

It is important to see a doctor when any unexplained pinprick red rash appears.