Thrombocytopenia differential diagnosis: Difference between revisions

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{{Thrombocytopenia}}
{{Thrombocytopenia}}
{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Farbod Zahedi Tajrishi|Farbod Zahedi Tajrishi, M.D.]]
{{CMG}}; {{AE}} [[User:Farbod Zahedi Tajrishi|Farbod Zahedi Tajrishi, M.D.]]


==Overview==
==Overview==
[[Thrombocytopenia]] has a broad range of potential causes. While a good [[History and Physical examination|history and physical examination]] can be helpful to diagnose some of these causes such as drug-induced thrombocytopenia, they usually don't suffice and further evaluation is often needed. There are also some useful points that may guide the [[physician]] to an appropriate [[diagnosis]]. For example, [[asymptomatic]], isolated [[thrombocytopenia]] most probably suggests [[Idiopathic thrombocytopenic purpura|ITP]], while [[thrombocytopenia]] in critically ill, hospitalized patients is usually suggestive of [[Iatrogenesis|iatrogenic]] causes (eg. [[dilution]]), [[platelet]] consumption, [[bone marrow suppression]] from [[infection]]/[[sepsis]], or even [[drug-induced thrombocytopenia]]. One should consider however, that a wide variety of other conditions such as [[autoimmune disorders]], [[nutrient]] deficiencies, [[thrombotic microangiopathies]] could all as well cause [[thrombocytopenia]].
[[Thrombocytopenia]] has a broad range of potential causes. While a good [[History and Physical examination|history and physical examination]] can be helpful to diagnose some of these causes such as drug-induced thrombocytopenia, they usually don't suffice and further evaluation is often needed. There are also some useful points that may guide the [[physician]] to an appropriate [[diagnosis]]. For example, [[asymptomatic]], isolated [[thrombocytopenia]] most probably suggests [[Idiopathic thrombocytopenic purpura|ITP]], while [[thrombocytopenia]] in critically ill, hospitalized patients is usually suggestive of [[Iatrogenesis|iatrogenic]] causes (eg. [[dilution]]), [[platelet]] consumption, [[bone marrow suppression]] from [[infection]]/[[sepsis]], or even [[drug-induced thrombocytopenia]]. One should consider however, that a wide variety of other conditions such as [[autoimmune disorders]], [[nutrient]] deficiencies, [[thrombotic microangiopathies]] could all as well cause [[thrombocytopenia]].


==Differential Diagnosis==
==Thrombocytopenia Differential Diagnosis==
{| class="wikitable"
'''Differentiating the diseases that can cause thrombocytopenia:'''
! rowspan="2" |Category
{|
!
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Disease
! rowspan="5" |Category
! rowspan="2" |History and symptoms
! colspan="2" rowspan="5" |Condition
! rowspan="2" |Physical exam
! rowspan="5" |Mechanism
! colspan="3" |Laboratory findings
! colspan="3" rowspan="4" |Mechanism
! rowspan="2" |Pathology
! rowspan="5" |Inherited
! rowspan="2" |Other specifics
! rowspan="5" |Acquried
! colspan="10" |Clinical manifestations
! colspan="10" rowspan="2" |Para−clinical findings
! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
|-
|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|[[White blood cells|WBC]] changes
! rowspan="4" |Age range
|[[Red blood cell|RBC/]][[hemoglobin]]<nowiki/>changes
! rowspan="4" |History
|other findings
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
| colspan="4" rowspan="2" |Signs
|-
|-
| rowspan="2" |'''Cardiovascular'''
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|
! colspan="9" |Lab Findings
|[[endocarditis]]<ref name="abc">Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis Accessed on September 24, 2015</ref>
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|
* [[Rigors]]
* [[Fever|Fevers]]
* [[Chills]]
* [[Anorexia]]
* [[Malaise]]
* [[Fatigue]]
* [[Weight loss]]
* [[Embolism|Embolic symptoms]]
|'''Skin'''
* [[Petechiae]]
* [[Splinter hemorrhages]]
* [[Osler's nodes]]
* [[Janeway lesion|Janeway lesions]]
Oral Cavity
* [[Periodontal diseases|Periodontal]] abnormalities
'''Eyes'''
* [[Conjunctival hemorrhage]]
* [[Roth's spot|Roth's spots]] in the [[retina]]
'''Ear Nose and Throat'''
* Bobbing of the [[uvula]] may be present among patients with new onset [[aortic regurgitation]].
'''Cardiovascular'''
* Heart [[Murmur|murmurs]]
* Wide [[pulse pressure]]
'''Lungs'''
* [[Rales]] as a result of [[heart failure]]
'''Abdomen'''
* [[Abdominal pain]] and [[reduced bowel sounds]] due to mesenteric embolization or [[ileus]]
* [[Splenomegaly]]
* [[Flank pain]] as a result of an [[embolus to the kidney]].
'''Neurologic'''
* [[Septic emboli]] may result in [[stroke]] and focal neurologic findings
* [[Seizures]]
* [[Intracranial hemorrhage]]
|    ↑
|<nowiki>-</nowiki>
|
* ↑ [[Erythrocyte sedimentation rate|ESR]]
* ↑ [[Rheumatoid factor|RF]], [[Blood urea nitrogen|BUN]] and [[Creatinine|Cr]] may also be present
|
'''Pathological Criteria'''
* Microorganisms demonstrated by culture or histological examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen
: OR
* Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
|'''Diagnostic criteria:<ref name="Durack">{{cite journal | author = Durack D, Lukes A, Bright D | title = New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. | journal = Am J Med | volume = 96 | issue = 3 | pages = 200-9 | year = 1994 | id = PMID 8154507}}</ref>'''
 
'''''Criteria for Rejecting the Diagnosis'''''
* Firm alternate diagnosis to infective endocarditis
* Resolution of infective endocarditis syndrome in under 4 days on antibiotics
* '''''Does not meet the criteria below:'''''
 
'''''Criteria for Definitive Endocarditis'''''
 
The Duke Clinical Criteria for definitive infective endocarditis require either:
* Two major criteria
: OR
* One major and three minor criteria
: OR
* Five minor criteria
 
=== Major Criteria ===
'''1. Positive Blood Culture for Infective Endocarditis'''
: '''A. Typical microorganism consistent with infective endocarditis from 2 separate blood cultures, as noted below:'''
:: ☑ [[Viridans streptococci]], ''[[Streptococcus bovis]]'', '''or'''
:: ☑ [[HACEK]] group, '''or'''
:: ☑ Community-acquired ''[[Staphylococcus aureus]]'' or [[enterococci]], in the absence of a primary focus
: OR
: '''B. Microorganisms consistent with infective endocarditis from persistently positive blood cultures defined as:'''
:: ☑ 2 positive cultures of blood samples drawn >12 hours apart, '''or'''
:: ☑ All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)
'''2. Evidence of endocardial involvement'''
: '''Positive echocardiogram for infective endocarditis defined as:'''
:: ☑ Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, '''or'''
:: ☑ On implanted material in the absence of an alternative anatomic explanation, '''or'''
:: ☑ Abscess, '''or'''
:: ☑ New partial dehiscence of prosthetic valve
: OR
:: ☑ New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)
'''Minor criteria:'''
: ☑ Predisposition: predisposing heart condition or [[intravenous drug use]]
: ☑ [[Fever]]: temperature > 38.0° C (100.4° F)
: ☑ Vascular phenomena: major arterial emboli, septic pulmonary infarcts, [[mycotic aneurysm]], [[intracranial hemorrhage]], [[Conjunctival hemorrhage|conjunctival hemorrhages]], and [[Janeway lesions]]
: ☑ Immunologic phenomena: [[glomerulonephritis]], [[Osler's nodes]], [[Roth spot|Roth spots]], and [[rheumatoid factor]]
: ☑ Microbiological evidence: positive [[blood culture]] but does not meet a major criterion as noted above (see footnote) or serological evidence of active infection with organism consistent with infectious endocarditis
: ☑ Echocardiographic findings: consistent with infectious endocarditis but do not meet a major criterion as noted above
: '''Footnote:''' It should be noted that the criteria exclude single positive cultures for [[coagulase-negative staphylococci]], diphtheroids, and organisms that do not commonly cause endocarditis.
|-
|-
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|[[pulmonary embolism]]<ref name="pmid241826422">{{cite journal| author=Cohen AT, Dobromirski M, Gurwith MM| title=Managing pulmonary embolism from presentation to extended treatment. | journal=Thromb Res | year= 2014 | volume= 133 | issue= 2 | pages= 139-48 | pmid=24182642 | doi=10.1016/j.thromres.2013.09.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24182642  }}</ref>
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Severity
|
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
* [[Dyspnea]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rash
* [[Pleuritic chest pain]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
* [[Fainting]]
! rowspan="2" |BP
* [[Cough]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Splenomegaly
* [[Substernal chest pain]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Jaundice
* [[Hemoptysis]]
! rowspan="2" |Other
* [[Wheezing]]
! colspan="3" |CBC
* [[Cyanosis]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |PBS
* [[Fever]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bone marrow exam
|
! rowspan="2" |PT
|
! rowspan="2" |PTT
|
! rowspan="2" |BT
|
! rowspan="2" |UA
* ↑ [[D-dimer]]
|
|
* positive findings on [[CT angiography|CT-angiogram]]
|-
|-
| rowspan="2" |'''Chemical/poisoning'''
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|
!Decreased platelet production
|[[Strontium-89]]
!Platelet destruction in bloodstream
|
!Platelet destruction in spleen/liver
|
!Plt
|
!HB
|
!WBC
|
|
|
|-
|-
|
! rowspan="15" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hematology
|[[zinc]]
! rowspan="4" align="center" style="background:#DCDCDC;" + |Bone marrow disorders
|
! align="center" style="background:#DCDCDC;" + |Myelodysplastic syndromes
|
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|-
|-
| rowspan="2" |'''Dermatologic'''
! align="center" style="background:#DCDCDC;" + |Aplastic anemia
|
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|[[Cholesterol embolism]]
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|'''General:'''
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* [[fever]],
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* [[myalgia]]
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* [[Weight loss#Unintentional weight loss|weight loss]]
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'''Organ-dependent:'''
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Lower extremities
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* [[Livedoid vasculitis|livedo reticularis]]
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Kidney
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* symptoms of [[Renal insufficiency|renal failure]] or [[nephrotic syndrome]]
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Gastroinstestinal
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* reduced appetite
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* nausea and vomiting
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* nonspecific [[abdominal pain]]
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* [[gastrointestinal hemorrhage]] 
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Central nervous system
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* [[stroke]]-like symptoms
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* [[headache]]
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* [[amaurosis fugax]]
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* [[paraparesis]]
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* [[cauda equina syndrome]]
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* loss of control over the [[bladder]], [[rectum]] and skin sensation around the anus
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* [[mononeuropathy]].
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|
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| ↑/-
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|↓/-
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|
:* ↑ [[Blood urea nitrogen|BUN]] and [[Creatinine|Cr]] in case of renal failure
:* ↑ [[Creatine kinase|CPK]] and [[troponin]] in case of myocardial infarction
:* [[Occult blood|OB]]+ in case of mesenteric ischemia
:* Peripheral [[eosinophilia]]
:* Urinary [[eosinophilia]] in patients with cholesterol-renal disease
:* [[Complement deficiency|Hypocomplementemia]]
:* ↑ [[Erythrocyte sedimentation rate|ESR]]
|<nowiki>-</nowiki>
|
|-
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! align="center" style="background:#DCDCDC;" + |Acute leukemia
|[[Griscelli syndrome|Griscelli syndrome]]
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|
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* characteristic [[hypopigmentation]]
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|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
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|-
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| rowspan="5" |'''Ear Nose Throat'''
! align="center" style="background:#DCDCDC;" + |Paroxysmal nocturnal hemoglobinuria (PNH)
|
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|[[Alport syndrome]]<ref name="pmid8414153">{{cite journal| author=Chugh KS, Sakhuja V, Agarwal A, Jha V, Joshi K, Datta BN et al.| title=Hereditary nephritis (Alport's syndrome)--clinical profile and inheritance in 28 kindreds. | journal=Nephrol Dial Transplant | year= 1993 | volume= 8 | issue= 8 | pages= 690-5 | pmid=8414153 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8414153 }}</ref><ref name="pmid11137428">{{cite journal| author=McCarthy PA, Maino DM| title=Alport syndrome: a review. | journal=Clin Eye Vis Care | year= 2000 | volume= 12 | issue= 3-4 | pages= 139-150 | pmid=11137428 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11137428 }}</ref><ref name="pmid1425373">{{cite journal| author=Andreoli SP, Deaton M| title=Alport's syndrome. | journal=Ear Nose Throat J | year= 1992 | volume= 71 | issue= 10 | pages= 508-11 | pmid=1425373 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1425373 }}</ref><ref name="pmid8238007">{{cite journal| author=Kashtan CE, Michael AF| title=Alport syndrome: from bedside to genome to bedside. | journal=Am J Kidney Dis | year= 1993 | volume= 22 | issue= 5 | pages= 627-40 | pmid=8238007 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8238007 }}</ref><ref name="pmid8327646">{{cite journal| author=Flinter F| title=Molecular genetics of Alport's syndrome. | journal=Q J Med | year= 1993 | volume= 86 | issue= 5 | pages= 289-92 | pmid=8327646 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8327646 }}</ref><ref name="pmid14253732">{{cite journal| author=Andreoli SP, Deaton M| title=Alport's syndrome. | journal=Ear Nose Throat J | year= 1992 | volume= 71 | issue= 10 | pages= 508-11 | pmid=1425373 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1425373 }}</ref><ref name="pmid7819734">{{cite journal| author=Amari F, Segawa K, Ando F| title=Lens coloboma and Alport-like glomerulonephritis. | journal=Eur J Ophthalmol | year= 1994 | volume= 4 | issue= 3 | pages= 181-3 | pmid=7819734 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7819734 }}</ref><ref name="pmid6871140">{{cite journal| author=Govan JA| title=Ocular manifestations of Alport's syndrome: a hereditary disorder of basement membranes? | journal=Br J Ophthalmol | year= 1983 | volume= 67 | issue= 8 | pages= 493-503 | pmid=6871140 | doi= | pmc=PMC1040106 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6871140 }}</ref>
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{| class="wikitable"
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|'''Renal'''
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|'''Auditory'''
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|'''Ocular'''
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! rowspan="3" align="center" style="background:#DCDCDC;" + |Thrombotic microangiopathy (TMA)
* Hematuria
! align="center" style="background:#DCDCDC;" + |Thrombotic thrombocytopenic purpura (TTP)
* Proteinuria
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* Hypertension
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* Reduced Creatinine Clearance
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|
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* Early Tinnitus
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* Vertigo
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* High-Frequency Progressive Bilateral Hearing Loss
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|
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* Refractory Error
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* Posterior Polymorphous Dystrophy
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* Arcus
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* Glaucoma
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* Vogt’s White Limbal Girdle
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* Band Keratopathy
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* Lenticonus
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* Spherophakia
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* Cataracts
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* Lens Coloboma
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* Anterior Lenticonus
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* Flecked Retinopathy of the Macula or Periphery
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|}
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|
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'''Vital signs'''
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* [[Systemic hypertension]] may be present
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'''Eyes'''
| align="center" style="background:#F5F5F5;" + |
 
| align="center" style="background:#F5F5F5;" + |
[[Fundoscopy]] shows:
| align="center" style="background:#F5F5F5;" + |
* [[Cataract|Cataracts]]
| align="center" style="background:#F5F5F5;" + |
* Subcapsular posterior lens opacities
* [[Lenticonus]]
* Retinal flecks (dot-and-fleck retinopathy)
* Posterior polymorphous corneal dystrophy/corneal epithelial erosions
'''Ears'''
* [[Sensorineural deafness|Sensorineural hearing loss]]
'''Extremities'''
* [[Peripheral edema]]
* [[Leiomyomatosis]]
'''Miscellaneous'''
* [[Anasarca]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
'''Urinalysis'''
* Microscopic [[hematuria]]
* [[Pyuria]]
* Red cell [[casts]]
* Cylindrical [[casts]]
* [[Proteinuria]]
'''Electrolytes and Metabolic'''
* ↑ [[Blood urea nitrogen|BUN]]
* ↑ [[Creatinine|Cr]]
* [[Hypoalbuminemia]]
|<nowiki>-</nowiki>
|'''Diagnostic criteria:'''<ref name="pmid23349312">{{cite journal| author=Savige J, Gregory M, Gross O, Kashtan C, Ding J, Flinter F| title=Expert guidelines for the management of Alport syndrome and thin basement membrane nephropathy. | journal=J Am Soc Nephrol | year= 2013 | volume= 24 | issue= 3 | pages= 364-75 | pmid=23349312 | doi=10.1681/ASN.2012020148 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23349312 }}</ref>
 
{| class="wikitable"
|'''Mandatory Criterion'''
|Persistent Hematuria
|-
|-
|'''Optional Criteria'''
! align="center" style="background:#DCDCDC;" + |Hemolytic uremic syndrome (HUS)
|''Presence of at Least 1 of 4'':
| align="center" style="background:#F5F5F5;" + |
* Positive Family History of Alport's Syndrome
| align="center" style="background:#F5F5F5;" + |
 
| align="center" style="background:#F5F5F5;" + |+
* Characteristic Clinical Features
| align="center" style="background:#F5F5F5;" + |
 
| align="center" style="background:#F5F5F5;" + |
* Characteristic Pathology Findings
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* Genetic Testing
| align="center" style="background:#F5F5F5;" + |
|}
| align="center" style="background:#F5F5F5;" + |
The equivocal or non-characteristic finding of any of the above prompts further work-up until the diagnosis is made or rejected.
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|-
|-
| rowspan="4" |[[MYH9]]-associated disorders
! align="center" style="background:#DCDCDC;" + |DIC
|[[Epstein's syndrome]]
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|
| align="center" style="background:#F5F5F5;" + | +
* [[epistaxis]]
| align="center" style="background:#F5F5F5;" + |
* [[Gastrointestinal bleeding]]
| align="center" style="background:#F5F5F5;" + |
* [[Hypertension]] (due to kidney disease)
| align="center" style="background:#F5F5F5;" + |
* [[Deafness]]
| align="center" style="background:#F5F5F5;" + |
* NO cataract
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|No [[White blood cells|leukocyte]] [[inclusion bodies]]
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
| rowspan="4" |
| align="center" style="background:#F5F5F5;" + |
* giant platelets on [[Blood film|PBS]]
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|-
|-
|[[Fechtner syndrome]]
! rowspan="7" align="center" style="background:#DCDCDC;" + |Congenital platelet disorders
|Same as [[Alport syndrome]]:
! align="center" style="background:#DCDCDC;" + |MYH-9 related disorders
* [[Sensorineural hearing loss|sensorineural deafness]]
| align="center" style="background:#F5F5F5;" + |
* [[ocular]] abnormalities such as [[cataract]]
| align="center" style="background:#F5F5F5;" + |
* [[nephritis]]
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|
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|
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* characteristic [[White blood cells|leukocyte]] [[inclusion bodies]] +
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| align="center" style="background:#F5F5F5;" + |
* impaired liver function and [[hypercholesterolemia]] in some cases
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|<nowiki>-</nowiki>
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|-
|-
|May–Hegglin Anomaly
! align="center" style="background:#DCDCDC;" + |Bernard-Soulier syndrome
|
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|
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|
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* characteristic [[White blood cells|leukocyte]] [[inclusion bodies]] +
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|<nowiki>-</nowiki>
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|-
|-
|[[Sebastian platelet syndrome|Sebastian Syndrome]]
! align="center" style="background:#DCDCDC;" + |Gray platelet syndrome
|same hematologic changes as those in the Fechtner syndrome but without the manifestations of [[Alport syndrome]].
| align="center" style="background:#F5F5F5;" + |
|
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|
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|
| align="center" style="background:#F5F5F5;" + |
* characteristic [[White blood cells|leukocyte]] [[inclusion bodies]] +
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|<nowiki>-</nowiki>
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|-
|-
|'''Endocrine'''
! align="center" style="background:#DCDCDC;" + |Wiskott-Aldrich syndrome
|
| align="center" style="background:#F5F5F5;" + |
|[[Immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
| align="center" style="background:#F5F5F5;" + |
|
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|-
|-
| rowspan="4" |'''Gastroenterologic'''
! align="center" style="background:#DCDCDC;" + |Thrombocytopenia with absent radius (TAR) syndrome
|
| align="center" style="background:#F5F5F5;" + |
|[[Aminoaciduria|Dibasic aminoaciduria type 2]]
| align="center" style="background:#F5F5F5;" + |
|
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|-
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|
! align="center" style="background:#DCDCDC;" + |Alport syndrome
|[[liver failure]]
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|-
|-
|
! align="center" style="background:#DCDCDC;" + |Von Willebrand disease
|[[Niemann-Pick disease|Niemann-Pick disease type b]]
| align="center" style="background:#F5F5F5;" + |
|
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|-
|-
|
! align="center" style="background:#DCDCDC;" + |Nutrient deficiencies
|[[portal hypertension]]
! align="center" style="background:#DCDCDC;" + |Folate, vitamin B12, copper
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + | +
|
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|-
| align="center" style="background:#F5F5F5;" + |
| rowspan="11" |'''Genetic'''
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|[[Aicardi-Goutieres syndrome]]
| align="center" style="background:#F5F5F5;" + |
|
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|-
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|[[Chediak-Higashi disease]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
* [[Dizziness]]
| align="center" style="background:#F5F5F5;" + |
* [[Weakness]]
| align="center" style="background:#F5F5F5;" + |
* [[Photophobia]]
| align="center" style="background:#F5F5F5;" + |
* [[Tremor]]
| align="center" style="background:#F5F5F5;" + |
* Photosensitive skin
| align="center" style="background:#F5F5F5;" + |
* [[Neuropathy]]
| align="center" style="background:#F5F5F5;" + |
* Frequent infections - [[Staphylococcus aureus]]
!
* [[Numbness]]
* [[Seizures]]
* [[ataxia]]
* Nosebleeds or easy [[bruising]]
* [[mental retardation]]
|'''Skin'''
* [[Hypopigmentation skin|Hypopigmentation]]
* Silvery hair
'''Eye'''
* [[Nystagmus]]
'''Abdomen'''
* [[Hepatomegaly]]
* [[Splenomegaly]]
'''Neurologic'''
* [[Neuropathy]]
|↓
|<nowiki>-</nowiki>
|
* [[Hypergammaglobulinemia]]
* ↑ [[Bleeding time]]
* ↑ [[bilirubin]]
* Peripheral blood smear - giant granules in neutrophils, eosinophils, and granulocytes
* Bone marrow smear - peroxidase positive giant inclusion bodies in leukocyte precursor cells. The inclusion bodies contain lysosomal enzymes.
|<nowiki>-</nowiki>
|
 
'''CT'''
* Brain and spinal cord atrophy
'''MRI'''
* Brain and spinal cord atrophy
'''EMG'''
* Delayed nerve conduction
'''EEG'''
* May reveal [[seizure]] activity
|-
|
|[[Factor H|complement factor H deficiency]]
|
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|
|
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|-
|
|[[Fanconi anaemia]]
|
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|
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|-
|
|[[holocarboxylase synthase deficiency]]
|
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|-
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|[[iminodipeptiduria]]
|
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|-
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|[[Jacobsen syndrome]]
|
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|-
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|[[MELAS]]
|
'''Early symptoms:'''
* [[Muscle weakness]]
* [[Muscle pain]]
* Recurrent [[headaches]]
* [[Loss of appetite]]
* [[Vomiting]]
* [[Seizures]]
* [[Abdominal pain]]
* [[fatigue]]
* [[Difficulty breathing]]
'''Eye'''
* Vision abnormalities
'''Ear'''
* [[Hearing loss]]
'''Extremeties'''
* [[Myoclonus]]
'''Neurologic'''
* [[Stroke]]-like episodes beginning before age 40
* [[hemiparesis]]
* [[Confusion|Altered consciousness]]
* [[Ataxia]]
* [[Seizures]]
* [[Dementia]]
|
|
|<nowiki>-</nowiki>
|
* [[lactic acidosis]]
|<nowiki>-</nowiki>
|
|-
|
|[[Omenn syndrome]]
|
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|-
|
|[[TAR syndrome]]
|Absent [[Radius (bone)|radius]]
|
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|
|
|
|-
|
|[[X-linked hyperimmunoglobulin M syndrome]]
|
|
|
|
|
|
|
|-
| rowspan="33" |'''Hematologic'''
|
|[[Acquired pure megakaryocytic aplasia]]
|
|
|
|
|
|
|
|-
|
|[[aplastic anemia]]
|
|
|<nowiki>+ / ↓</nowiki>
|<nowiki>+ / ↓</nowiki>
|
|
|
|-
|
|[[Bernard-Soulier syndrome]]
|
|
|
|
|
|
|
|-
|
|[[Thrombocytopenia|congenital amegakaryocytic thrombocytopenia (CAMT)]]
|
|
|
|
|
|
|
|-
|
|[[disseminated intravascular coagulation]]
|
|
|
|
|
|
|
|-
|
|[[Epstein's syndrome]]
|
|
|
|
|
|
|
|-
|
|[[familial histiocytic reticulosis]]
|
|
|
|
|
|
|
|-
|
|[[Gasser syndrome]]
|
|
|
|
|
|
|
|-
|
|[[GATA1|GATA1-related cytopenia]]
|
|
|
|
|
|
|
|-
|
|[[Glanzmann's thrombasthenia]]
|
|
|
|
|
|
|
|-
|
|[[grey platelet syndrome]]
|
|
|
|
|
|
|
|-
|
|[[hemolytic uremic syndrome]]
|
|
|
|
|
|
|
|-
|
|[[histiocytosis X]]
|
|
|
|
|
|
|
|-
|
|[[hypersplenism]]
|
|
|
|
|
|
|
|-
|
|[[idiopathic thrombocytopenic purpura]]
|
|
|
|
|
|
|
|-
|
|[[Jacobsen syndrome]]
|
|
|
|
|
|
|
|-
|
|[[Kasabach-Merritt syndrome]]
|
|
|
|
|
|
|
|-
|
|[[May-Hegglin anomaly]]
|
|
|
|
|
|
|
|-
|
|[[Moschcowitz syndrome]]
|
|
|
|
|
|
|
|-
|
|[[myelodysplastic syndrome]]
|
|
|
|
|
|
|
|-
|
|[[myelofibrosis]]
|
|
|
|
|
|
|
|-
|
|[[neonatal alloimmune thrombocytopenia]]
|
|
|
|
|
|
|
|-
|
|[[pancytopenia]]
|
|
|
|
|
|
|
|-
|
|Paris-Trousseau thrombocytopenia
|
|
|
|
|
|
|
|-
|
|[[paroxysmal nocturnal hemoglobinuria]]
|
|
|
|
|
|
|
|-
|
|[[post-transfusion purpura]]
|
|
|
|
|
|
|
|-
|
|[[TAR syndrome|radial aplasia-thrombocytopenia syndrome]]
|
|
|
|
|
|
|
|-
|
|[[Sebastian platelet syndrome]]
|
|
|
|
|
|
|
|-
|
|[[Shwachman-Diamond syndrome]]
|
|
|
|
|
|
|
|-
|
|[[thrombotic thrombocytopenic purpura]]
|
|
|
|
|
|
|
|-
|
|[[Von Willebrand disease|Von Willebrand disease, platelet type]]
|
|
|
|
|
|
|
|-
|
|[[Werlhof disease]]
|
|
|
|
|
|
|
|-
|
|[[Wiskott-Aldrich syndrome]]
|
|
|
|
|
|
|
|-
| rowspan="5" |'''Iatrogenic'''
|
|[[Coronary artery bypass surgery|Cardiac bypass]]
|
|
|
|
|
|
|
|-
|
|[[chemotherapy]]
|
|
|
|
|
|
|
|-
|
|[[Intra-aortic balloon pump|intra-aortic balloon pump placement]]
|
|
|
|
|
|
|
|-
|
|[[Blood transfusion|massive blood transfusion]]
|
|
|
|
|
|
|
|-
|
|[[radiation therapy]]
|
|
|
|
|
|
|
|-
| rowspan="25" |'''Infectious diseases'''
|
|[[Congenital syphilis]]
|
|
|
|
|
|
|
|-
|
|[[cytomegalovirus]]
|
|
|
|
|
|
|
|-
|
|[[Dengue fever]]
|
|
|
|
|
|
|
|-
|
|[[ehrlichiosis]]
|
|
|
|
|
|
|
|-
|
|[[Epstein-Barr virus]]
|
|
|
|
|
|
|
|-
|
|[[hantavirus]]
|
|
|
|
|
|
|
|-
|
|[[hepatitis C]]
|
|
|
|
|
|
|
|-
|
|[[HIV]]
|
|
|
|
|
|
|
|-
|
|[[human granulocytic ehrlichiosis]]
|
|
|
|
|
|
|
|-
|
|[[Ehrlichiosis|human monocytotropic ehrlichiosis]]
|
|
|
|
|
|
|
|-
|
|[[lassa fever]]
|
|
|
|
|
|
|
|-
|
|[[leptospirosis]]
|
|
|
|
|
|
|
|-
|
|[[malaria]]
|
|
|
|
|
|
|
|-
|
|[[measles]]
|
|
|
|
|
|
|
|-
|
|[[mumps]]
|
|
|
|
|
|
|
|-
|
|[[mycoplasma pneumonia]]
|
|
|
|
|
|
|
|-
|
|[[Relapsing fever|Oklahoma tick fever]]
|
|
|
|
|
|
|
|-
|
|[[parvovirus]]
|
|
|
|
|
|
|
|-
|
|[[Q fever]]
|
|
|
|
|
|
|
|-
|
|[[rubella]]
|
|
|
|
|
|
|
|-
|
|sepsis
|
|
|
|
|
|
|
|-
|
|[[tick-borne encephalitis]]
|
|
|
|
|
|
|
|-
|
|[[Toxic shock syndrome|toxic shock syndrome (staphylococcal)]]
|
|
|
|
|
|
|
|-
|
|[[varicella]]
|
|
|
|
|
|
|
|-
|
|[[visceral leishmaniasis]]
|
|
|
|
|
|
|
|-
|-
| rowspan="14" |'''Nutritional/Metabolic'''
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|
!Category
|[[folate deficiency]]
! colspan="2" |Condition
|
!Mechanism
|
!Decreased platelet production
|
!Platelet destruction in bloodstream
|
!Platelet destruction in spleen/liver
|
!Inherited
|
!Acquried
|
!Age range
!History
!Severity
!Fever
!Rash
!Bleeding
!BP
!Splenomegaly
!Jaundice
!Other signs
!Plt
!HB
!WBC
!PBS
!Bone marrow exam
!PT
!PTT
!BT
!UA
!Imaging
!Gold standard
!Associated findings
|-
|-
|
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rheumatologic/autoimmune disorders
|[[Gaucher disease]]
! colspan="2" align="center" style="background:#DCDCDC;" + |Immune thrombocytopenia
|
| align="center" style="background:#F5F5F5;" + |Antibody-mediated platelet destruction
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Systemic lupus erythematosus (SLE)
|[[holocarboxylase synthase deficiency]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Antiphospholipid syndrome (APS)
|[[iminodipeptiduria]]
| align="center" style="background:#F5F5F5;" + |Autoantibody-mediated syndrome
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Felty's syndrome
|[[iron deficiency]]
| align="center" style="background:#F5F5F5;" + |Splenomegaly
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! rowspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection-induced
|[[isovaleric acidaemia]]
! rowspan="3" align="center" style="background:#DCDCDC;" + |Bacterial infections
|
! align="center" style="background:#DCDCDC;" + |Sepsis
|
| align="center" style="background:#F5F5F5;" + |Direct bone marrow suppression
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! align="center" style="background:#DCDCDC;" + |Helicobacter pylori
|[[Methylmalonic aciduria|methylmalonic aciduria type 2]]
| align="center" style="background:#F5F5F5;" + |Immune thrombocytopenia
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! align="center" style="background:#DCDCDC;" + |Tick-borne infection
|[[CD36|platelet glycoprotein 4 deficiency]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! rowspan="2" align="center" style="background:#DCDCDC;" + |Viral infections
|[[platelet glycoprotein Ib deficiency]]
! align="center" style="background:#DCDCDC;" + |HIV
|
| align="Left" style="background:#F5F5F5;" + |
|
* Direct toxicity to megakaryocytes
|
* An ITP-like condition called primary HIV-associated thrombocytopenia (PHAT)
|
* Secondary opportunistic infections
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! align="center" style="background:#DCDCDC;" + |Other viruses such as rubella, mumps, varicella, parvovirus, hepatitis C, & Epstein-Barr virus
|[[prolidase deficiency]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! rowspan="2" align="center" style="background:#DCDCDC;" + |Intracellular parasites
|[[propionyl-CoA carboxylase deficiency]]
! align="center" style="background:#DCDCDC;" + |Malaria
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! align="center" style="background:#DCDCDC;" + |Babesiosis
|[[sea blue histiocytosis]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|[[sitosterolemia]]
!Category
|
! colspan="2" |Condition
|
!Mechanism
|
!Decreased platelet production
|
!Platelet destruction in bloodstream
|
!Platelet destruction in spleen/liver
|
!Inherited
|
!Acquried
!Age range
!History
!Severity
!Fever
!Rash
!Bleeding
!BP
!Splenomegaly
!Jaundice
!Other signs
!Plt
!HB
!WBC
!PBS
!Bone marrow exam
!PT
!PTT
!BT
!UA
!Imaging
!Gold standard
!Associated findings
|-
|-
|
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Medication/toxicity
|[[vitamin B12 deficiency]]
! align="center" style="background:#DCDCDC;" + |Drug-induced immune thrombocytopenia
|
! align="left" style="background:#DCDCDC;" + |
|
* Antibiotics
|
** Sulfonamides
|
** Ampicillin
|
** Piperacillin
|
** Vancomycin
|
** Rifampin
* Older antiepileptic agents
** carbamazepine
** Phenytoin
* Quinine
| align="center" style="background:#F5F5F5;" + |Occurrence of drug-dependent, platelet-reactive antibodies
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
| rowspan="2" |'''Obstetric/Gynecologic'''
! colspan="2" align="center" style="background:#DCDCDC;" + |Heparin-induced thrombocytopenia
|
| align="center" style="background:#F5F5F5;" + |
|[[Eclampsia]], [[pre-eclampsia]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Cytotoxic chemotherapy
|[[HELLP syndrome]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
| rowspan="11" |'''Oncologic'''
! colspan="2" align="center" style="background:#DCDCDC;" + |Radiation therapy
|
| align="center" style="background:#F5F5F5;" + |Predictable, dose-dependent myelosuppression
|[[Acute lymphoblastic leukemia]]
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! align="center" style="background:#DCDCDC;" + |OTC agents
|[[acute myeloid leukemia]]
! align="center" style="background:#DCDCDC;" + |Quinine-containing beverages
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |GI
|[[acute promyelocytic leukemia]]
! colspan="2" align="center" style="background:#DCDCDC;" + |Chronic liver disease
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Portal hypertension
|[[chronic lymphocytic leukaemia]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|[[chronic myeloid leukaemia]]
!Category
|
! colspan="2" |Condition
|
!Mechanism
|
!Decreased platelet production
|
!Platelet destruction in bloodstream
|
!Platelet destruction in spleen/liver
|
!Inherited
|
!Acquried
!Age range
!History
!Severity
!Fever
!Rash
!Bleeding
!BP
!Splenomegaly
!Jaundice
!Other signs
!Plt
!HB
!WBC
!PBS
!Bone marrow exam
!PT
!PTT
!BT
!UA
!Imaging
!Gold standard
!Associated findings
|-
|-
|
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Vascular
|[[hairy cell leukaemia]]
! colspan="2" align="center" style="background:#DCDCDC;" + |Giant capillary hemangioma
|
| align="center" style="background:#F5F5F5;" + |Platelet destruction
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Aortic aneurysm
|[[hepatosplenic T-cell lymphoma]]
| align="center" style="background:#F5F5F5;" + |Platelet destruction
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Cardiopulmonary bypass
|[[lymphoma]]
| align="center" style="background:#F5F5F5;" + |Platelet destruction
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|[[myeloma]]
! colspan="2" align="center" style="background:#DCDCDC;" + |Alcohol
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Post-transfusion purpura
|[[Non-Hodgkins lymphoma]]
| align="center" style="background:#F5F5F5;" + |Immune mediated platelet destruction
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |+
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| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
|
! colspan="2" align="center" style="background:#DCDCDC;" + |Gestational thrombocytopenia
|[[paraneoplastic syndrome]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|-
| align="center" style="background:#F5F5F5;" + |
| rowspan="2" |'''Overdose/Toxicity'''
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|[[ethanol]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|-
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|[[arsenic trioxide]]
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
|-
|'''Pulmonary'''
|
|[[Acute respiratory distress syndrome]]
|
|
|
|
|
|
|
|-
|'''Renal/Electrolyte'''
|
|[[hemolytic uremic syndrome]]
|
|
|
|
|
|
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|-
| rowspan="10" |'''Rheumatology/Immunology/Allergy'''
|
|[[Anticardiolipin syndrome]]
|
|
|
|
|
|
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|-
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|[[antiphospholipid syndrome]]
|
|
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|-
|
|[[autoimmune lymphoproliferative syndrome type 1]]
|
|
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|-
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|[[autoimmune lymphoproliferative syndrome type 2]]
|
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|-
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|[[Factor H|complement factor H deficiency]]
|
|
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|-
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|[[Evans syndrome]]
|
|
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|-
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|[[immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
|
|
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|
|
|
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|-
|
|[[macrophage-activation syndrome]]
|
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|-
|
|[[neonatal alloimmune thrombocytopenia]]
|
|
|
|
|
|
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|-
|
|[[systemic lupus erythematosus]]
|
|
|
|
|
|
|
|-
|'''Miscellaneous'''
|
|[[Snakebites]]
|
|
|
|
|
|
|
|}
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Hematology]]
{{WS}}
{{WH}}

Revision as of 22:38, 14 August 2018

Thrombocytopenia Microchapters

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

Overview

Thrombocytopenia has a broad range of potential causes. While a good history and physical examination can be helpful to diagnose some of these causes such as drug-induced thrombocytopenia, they usually don't suffice and further evaluation is often needed. There are also some useful points that may guide the physician to an appropriate diagnosis. For example, asymptomatic, isolated thrombocytopenia most probably suggests ITP, while thrombocytopenia in critically ill, hospitalized patients is usually suggestive of iatrogenic causes (eg. dilution), platelet consumption, bone marrow suppression from infection/sepsis, or even drug-induced thrombocytopenia. One should consider however, that a wide variety of other conditions such as autoimmune disorders, nutrient deficiencies, thrombotic microangiopathies could all as well cause thrombocytopenia.

Thrombocytopenia Differential Diagnosis

Differentiating the diseases that can cause thrombocytopenia:

Category Condition Mechanism Mechanism Inherited Acquried Clinical manifestations Para−clinical findings Gold standard Associated findings
Age range History Symptoms Signs
Lab Findings Imaging
Severity Fever Rash Bleeding BP Splenomegaly Jaundice Other CBC PBS Bone marrow exam PT PTT BT UA
Decreased platelet production Platelet destruction in bloodstream Platelet destruction in spleen/liver Plt HB WBC
Hematology Bone marrow disorders Myelodysplastic syndromes +
Aplastic anemia +
Acute leukemia +
Paroxysmal nocturnal hemoglobinuria (PNH) +
Thrombotic microangiopathy (TMA) Thrombotic thrombocytopenic purpura (TTP) +
Hemolytic uremic syndrome (HUS) +
DIC +
Congenital platelet disorders MYH-9 related disorders
Bernard-Soulier syndrome
Gray platelet syndrome
Wiskott-Aldrich syndrome
Thrombocytopenia with absent radius (TAR) syndrome
Alport syndrome
Von Willebrand disease
Nutrient deficiencies Folate, vitamin B12, copper +
Category Condition Mechanism Decreased platelet production Platelet destruction in bloodstream Platelet destruction in spleen/liver Inherited Acquried Age range History Severity Fever Rash Bleeding BP Splenomegaly Jaundice Other signs Plt HB WBC PBS Bone marrow exam PT PTT BT UA Imaging Gold standard Associated findings
Rheumatologic/autoimmune disorders Immune thrombocytopenia Antibody-mediated platelet destruction +
Systemic lupus erythematosus (SLE)
Antiphospholipid syndrome (APS) Autoantibody-mediated syndrome
Felty's syndrome Splenomegaly
Infection-induced Bacterial infections Sepsis Direct bone marrow suppression + +
Helicobacter pylori Immune thrombocytopenia +
Tick-borne infection +
Viral infections HIV
  • Direct toxicity to megakaryocytes
  • An ITP-like condition called primary HIV-associated thrombocytopenia (PHAT)
  • Secondary opportunistic infections
Other viruses such as rubella, mumps, varicella, parvovirus, hepatitis C, & Epstein-Barr virus +
Intracellular parasites Malaria
Babesiosis
Category Condition Mechanism Decreased platelet production Platelet destruction in bloodstream Platelet destruction in spleen/liver Inherited Acquried Age range History Severity Fever Rash Bleeding BP Splenomegaly Jaundice Other signs Plt HB WBC PBS Bone marrow exam PT PTT BT UA Imaging Gold standard Associated findings
Medication/toxicity Drug-induced immune thrombocytopenia
  • Antibiotics
    • Sulfonamides
    • Ampicillin
    • Piperacillin
    • Vancomycin
    • Rifampin
  • Older antiepileptic agents
    • carbamazepine
    • Phenytoin
  • Quinine
Occurrence of drug-dependent, platelet-reactive antibodies
Heparin-induced thrombocytopenia +
Cytotoxic chemotherapy +
Radiation therapy Predictable, dose-dependent myelosuppression +
OTC agents Quinine-containing beverages
GI Chronic liver disease +
Portal hypertension
Category Condition Mechanism Decreased platelet production Platelet destruction in bloodstream Platelet destruction in spleen/liver Inherited Acquried Age range History Severity Fever Rash Bleeding BP Splenomegaly Jaundice Other signs Plt HB WBC PBS Bone marrow exam PT PTT BT UA Imaging Gold standard Associated findings
Vascular Giant capillary hemangioma Platelet destruction +
Aortic aneurysm Platelet destruction +
Cardiopulmonary bypass Platelet destruction +
Other Alcohol +
Post-transfusion purpura Immune mediated platelet destruction +
Gestational thrombocytopenia

References