Thrombocytopenia differential diagnosis

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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

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.

Differential Diagnosis

Category	Disease	History and symptoms	Laboratory findings	Pathology
Cardiovascular	endocarditis
	pulmonary embolism
Chemical/poisoning	Strontium-89
	zinc
Dermatologic	Cholesterol embolism
	Elejalde syndrome
	Griscelli syndrome type 1
	neuroectodermal melanolysosomal disease
Hematologic	Acquired pure megakaryocytic aplasia
	aplastic anemia
	Bernard-Soulier syndrome
	congenital amegakaryocytic thrombocytopenia (CAMT)
	disseminated intravascular coagulation
	Epstein's syndrome
	familial histiocytic reticulosis
	Gasser syndrome
	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
	radial aplasia-thrombocytopenia syndrome
	Sebastian platelet syndrome
	Shwachman-Diamond syndrome
	thrombotic thrombocytopenic purpura
	Von Willebrand disease
	Werlhof disease
	Wiskott-Aldrich syndrome