Thrombocytopenia resident survival guide

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.

• Disseminated intravascular coagulation

Common Causes

• Bone marrow suppression (for example chemotherapy, irradiation)
• Chronic alcohol use
• Chronic liver disease
• Congenital thrombocytopenia
• Disseminated intravascular coagulation
• Drug-induced thrombocytopenia
• Gestational thrombocytopenia
• HELLP syndrome
• Hemolytic uremic syndrome
• Heparin-induced thrombocytopenia
• Immune thrombocytopenic purpura
• Infections
• Preeclampsia
• Pseudothrombocytopenia
• Thrombotic thrombocytopenic purpura

Management

Shown below is an algorithm 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

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.
• 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.