Thrombocytopenia resident survival guide: Difference between revisions
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{{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% "> Schistocytes</div>|D02= Spherocytes|D03= Dacrocytes|D04= Hypersegmented neurophils <br> Macrocytosis|D05= Neutrophilia <br> Lymphocytosis <br> Leukopenia <br> Toxic granulations|D06= Blasts|D07= Isolated thrombocytopenia}} | {{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% "> Schistocytes</div>|D02= Spherocytes|D03= Dacrocytes|D04= Hypersegmented neurophils <br> Macrocytosis|D05= Neutrophilia <br> Lymphocytosis <br> Leukopenia <br> Toxic granulations|D06= Blasts|D07= Isolated thrombocytopenia}} | ||
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{{familytree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | | | | | |E01= | {{familytree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | | | | | |E01= DIC <br> TTP/HUS|E02= Evans syndrome <br> Hypersplenism|E03= Myelofibrosis|E04= Vit. B12 deficiency <br> Folate deficiency|E05= Infections|E06= Bone marrow disorders|E07= ITP <br> Drug-induced thrombocytopenia <br> [[HIV]], HCV <br> H. pylori <br> HIT <br> [[DIC]] <br> Gestational thrombocytopenia}} | ||
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Revision as of 19:27, 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
- 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 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 Drug-induced thrombocytopenia HIV, HCV H. pylori HIT DIC Gestational thrombocytopenia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.