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Thrombocytopenia Differential Diagnosis

Differentiating the diseases that can cause thrombocytopenia:

Category	Condition		Mechanism				Age range		Clinical manifestations										Para−clinical findings										Gold standard	Associated findings
									Symptoms							Signs
																			Lab Findings									Imaging
									Severity	Fever	Bleeding					BP	Splenomegaly		CBC			PBS	Bone marrow exam
				Myelosuppression	Platelet destruction in bloodstream	Platelet destruction in spleen/liver		History											Plt	HB	WBC			PT	PTT	BT
Hematology	Bone marrow disorders	Myelodysplastic syndromes
		Aplastic anemia
		Acute leukemia
		Paroxysmal nocturnal hemoglobinuria (PNH)																											Diagnosis of exclusion
	Thrombotic microangiopathy (TMA)	Thrombotic thrombocytopenic purpura (TTP)
		Hemolytic uremic syndrome (HUS)
	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	an autoimmune mechanism
Rheumatologic/autoimmune disorders	Immune thrombocytopenia		Antibody-mediated platelet destruction						Moderate to severe	-
	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
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								Mild
	Portal hypertension
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