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
Ear Nose Throat	Alport syndrome
	Arias oculootoradial syndrome
	Epstein's syndrome
	Fechtner syndrome
Endocrine	Immunodysregulation polyendocrinopathy and enteropathy, X-linked
Gastroenterologic	Dibasic aminoaciduria type 2
	liver failure
	Niemann-Pick disease type b
	portal hypertension
Genetic	Aicardi-Goutieres syndrome
	Chediak-Higashi disease
	complement factor H deficiency
	Elejalde syndrome
	Fanconi anaemia
	Fechtner syndrome
	Griscelli syndrome type 1
	holocarboxylase synthase deficiency
	iminodipeptiduria
	Jacobsen syndrome
	MELAS
	Omenn syndrome
	TAR syndrome
	X-linked hyperimmunoglobulin M syndrome
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, platelet type
	Werlhof disease
	Wiskott-Aldrich syndrome
Iatrogenic	Cardiac bypass
	chemotherapy
	intra-aortic balloon pump placement
	massive blood transfusion
	radiation therapy
Infectious diseases	Congenital syphilis
	cytomegalovirus
	Dengue fever
	ehrlichiosis
	Epstein-Barr virus
	hantavirus
	hepatitis C
	HIV
	human granulocytic ehrlichiosis
	human monocytotropic ehrlichiosis
	lassa fever
	leptospirosis
	malaria
	measles
	mumps
	mycoplasma pneumonia
	Oklahoma tick fever
	parvovirus
	Q fever
	rubella
	sepsis
	tick-borne encephalitis
	toxic shock syndrome (staphylococcal)
	varicella
	visceral leishmaniasis
Musculoskeletal/Orthopedic	cholesterol embolism, radial aplasia-thrombocytopenia syndrome, TAR syndrome, thrombocytopenia absent radius syndrome
Nutritional/Metabolic	Dibasic aminoaciduria type 2, folate deficiency, Gaucher disease, holocarboxylase synthase deficiency, iminodipeptiduria, iron deficiency, isovaleric acidaemia, methylmalonic aciduria type 2, platelet glycoprotein 4 deficiency, platelet glycoprotein Ib deficiency, prolidase deficiency, propionyl-CoA carboxylase deficiency, sea blue histiocytosis, sitosterolemia, vitamin B12 deficiency
Obstetric/Gynecologic	Eclampsia, HELLP syndrome, pre-eclampsia
Oncologic	Acute lymphoblastic leukemia, acute myeloid leukemia, acute promyelocytic leukemia, chronic lymphocytic leukaemia, chronic myeloid leukaemia, hairy cell leukaemia, hepatosplenic T-cell lymphoma, , lymphoma, myeloma, Non-Hodgkins lymphoma, paraneoplastic syndrome
Overdose/Toxicity	Alcohol, arsenic trioxide, ethanol
Pulmonary	Acute respiratory distress syndrome
Renal/Electrolyte	Epstein's syndrome, Fechtner syndrome, hemolytic uremic syndrome
Rheumatology/Immunology/Allergy	Anticardiolipin syndrome, antiphospholipid syndrome, autoimmune lymphoproliferative syndrome type 1, autoimmune lymphoproliferative syndrome type 2, complement factor H deficiency, Evans syndrome, immunodysregulation polyendocrinopathy and enteropathy, X-linked, macrophage-activation syndrome, neonatal alloimmune thrombocytopenia, Omenn syndrome, paraneoplastic syndrome, systemic lupus erythematosus, Wiskott-Aldrich syndrome, X-linked hyperimmunoglobulin M syndrome
Miscellaneous	Snakebites