Thrombocytopenia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor-In-Chief: Farbod Zahedi Tajrishi, M.D.

Overview

On physical examination of patients with thrombocytopenia, the physician should search for signs of bleeding on skin and in other organ systems, lymphadenopathy, hepatosplenomegaly and signs of thrombosis, all of which could be a guide for the diagnosis of the underlying cause.

Physical Examination

A set of signs can be present in thrombocytopenia, each of which suggesting different potential underlying causes. These include:

• signs of bleeding

• lymphadenopathy

• hepatosplenomegaly

• Signs of thrombosis

physical finding	categories	further explanations
bleeding	skin petechiae purpura overt mucusal bleeding other sites	- Bleeding into the skin in the form of petechiae, purpura or overt mucusal bleeding is common in thrombocytopenia. Thrombocytopenic Bleeding due to thrombocytopenia is different from the bleeding seen in coagulopathies. - Wet purpura often suggests a higher probability of serious bleedings. Palpable purpura is not common in thrombocytopenia and is mostly seen in vascular or inflammatory diseases. - Bleeding may also happen in every other organ systems, including the gastrointestinal tract (eg. occult blood in the stool) or genitourinary tract (eg. hematuria). In these settings, appropriate evaluation of bleeding is warranted even if the etiology of thrombocytopenia is clear.
hepatosplenomegaly	Hepatosplenomegaly may suggest one of these conditions: liver disease lymphoma other hematologic conditions	Splenomegaly due to any etiology could result in mild thrombocytopenia.
lymphadenopathy	focal generalized	- Lymphadenopathy and coexisting thrombocytopenia could be a sign of: infection lymphoma other malignancies - Focal, tender lymphadenopathy most commonly suggests localized bacterial infection. - Generalized lymphadenopathy could be a sign of acute HIV infection.
thromboses	-	- Though not common, patients with thrombocytopenia are at risk of thrombosis rather than bleeding in certain conditions. Examples of these life-threatening conditions include: HIT DIC APS TTP PNH