Thrombocytopenia resident survival guide: Difference between revisions
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*[[Bone marrow suppression]] (for example chemotherapy, irradiation) | *[[Bone marrow suppression]] (for example chemotherapy, irradiation) | ||
*Chronic alcohol use | *Chronic alcohol use | ||
*[[Chronic liver disease]] | *[[Chronic liver disease]]<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref> | ||
*Congenital thrombocytopenia | *Congenital thrombocytopenia | ||
*[[Disseminated intravascular coagulation]] | *[[Disseminated intravascular coagulation]]<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref> | ||
*Drug-induced thrombocytopenia (DITP) | *Drug-induced thrombocytopenia (DITP)<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref> | ||
*Gestational thrombocytopenia | *Gestational thrombocytopenia | ||
*[[HELLP syndrome]] | *[[HELLP syndrome]] | ||
| Line 24: | Line 24: | ||
*[[Heparin-induced thrombocytopenia]] | *[[Heparin-induced thrombocytopenia]] | ||
*[[Immune thrombocytopenic purpura]]<ref name="pmid24397048">{{cite journal| author=Farid J, Gul N, Qureshi WU, Idris M| title=Clinical presentations in immune thrombocytopenic purpura. | journal=J Ayub Med Coll Abbottabad | year= 2012 | volume= 24 | issue= 2 | pages= 39-40 | pmid=24397048 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24397048 }} </ref> | *[[Immune thrombocytopenic purpura]]<ref name="pmid24397048">{{cite journal| author=Farid J, Gul N, Qureshi WU, Idris M| title=Clinical presentations in immune thrombocytopenic purpura. | journal=J Ayub Med Coll Abbottabad | year= 2012 | volume= 24 | issue= 2 | pages= 39-40 | pmid=24397048 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24397048 }} </ref> | ||
*[[Infections]] | *[[Infections]]<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref> | ||
*[[Preeclampsia]] | *[[Preeclampsia]] | ||
*Pseudothrombocytopenia | *Pseudothrombocytopenia | ||
Revision as of 20:15, 15 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Introduction
Thrombocytopenia refers to relatively few platelets in blood. A normal platelet count ranges from 150,000 to 450,000 per microliter of blood, determined by the 2.5th lower percentile of the normal platelet count distribution.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Bone marrow suppression (for example chemotherapy, irradiation)
- Chronic alcohol use
- Chronic liver disease[1]
- Congenital thrombocytopenia
- Disseminated intravascular coagulation[1]
- Drug-induced thrombocytopenia (DITP)[1]
- Gestational thrombocytopenia
- HELLP syndrome
- Hemolytic uremic syndrome
- Heparin-induced thrombocytopenia
- Immune thrombocytopenic purpura[2]
- Infections[1]
- Preeclampsia
- Pseudothrombocytopenia
- Thrombotic thrombocytopenic purpura[3]
Management
Shown below are algorithms summarizing the approach to thrombocytopenia.
Characterize the symptoms: ❑ Easy bruising ❑Petechiae ❑ Rashes ❑ Melena ❑ Fevers ❑ Bleeding ❑ Headaches ❑ Abdominal pain ❑ Visual disturbances ❑ Weight loss ❑ Night sweats ❑ Bone pain History/Epidemiological factors: ❑ Recent medications ❑ Pregnancy ❑ Family history ❑ Medical history ❑ Recent vaccinations ❑ Recent travels ❑ Recent transfusions ❑ Chronic alcohol use ❑ Recent hospitalization ❑ Recent organ transplantation ❑ Recent valve replacement surgery ❑ Dietary habits ❑ Sexual history ❑ Ingestion of quinine containing beverages | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| B01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| CO1 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| D01 | D02 | D03 | D04 | D05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| E01 | E02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Algorithm for Diagnosis of Thrombocytopenia based on the Peripheral Blood Smear
| Thrombocytopenia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Platelet clumping | Examine peripheral blood smear | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pseudothrombocytopenia | True thrombocytopenia | Giant platelets ±WBC inclusions | Congenital/Hereditary thrombocytopenia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schistocytes | Spherocytes | Dacrocytes | Hypersegmented neurophils Macrocytosis | Neutrophilia Lymphocytosis Leukopenia Toxic granulations | Blasts | Isolated thrombocytopenia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DIC TTP/HUS | Evans syndrome Hypersplenism | Myelofibrosis | Vit. B12 deficiency Folate deficiency | Infections | Bone marrow disorders | ITP DITP HIV, HCV H. pylori HIT DIC Gestational thrombocytopenia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Algorithm based on the 2012 American Society of Hematology Evidence-Based Approaches to Cytopenias.[4]
Do's
- Bone marrow biopsy should be done for patients that are older than 60 years of age to rule out myelodysplastic syndrome or lymphoproliferative disorders.
- Treatment should be considered for patients with platelet counts less than 30,000 per microliter.
Dont's
- Do not initiate cancer chemotherapy or antiviral therapy in the presence of thrombocytopenia.[4]
- Do not start treatment for platelet counts greater than 50,000 per microliter unless actively bleeding.
- Don't give warfarin (coumadin) monotherapy to an acutely bleeding patient because it may induce thrombosis.
References
- ↑ 1.0 1.1 1.2 1.3 Greenberg EM, Kaled ES (2013). "Thrombocytopenia". Crit Care Nurs Clin North Am. 25 (4): 427–34, v. doi:10.1016/j.ccell.2013.08.003. PMID 24267279.
- ↑ Farid J, Gul N, Qureshi WU, Idris M (2012). "Clinical presentations in immune thrombocytopenic purpura". J Ayub Med Coll Abbottabad. 24 (2): 39–40. PMID 24397048.
- ↑ Abdel Karim N, Haider S, Siegrist C, Ahmad N, Zarzour A, Ying J; et al. (2013). "Approach to management of thrombotic thrombocytopenic purpura at university of cincinnati". Adv Hematol. 2013: 195746. doi:10.1155/2013/195746. PMC 3876823. PMID 24396345.
- ↑ 4.0 4.1 Stasi R (2012). "How to approach thrombocytopenia". Hematology Am Soc Hematol Educ Program. 2012: 191–7. doi:10.1182/asheducation-2012.1.191. PMID 23233580.