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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