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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
	Gestational thrombocytopenia
	Chronic liver disease
	portal hypertension
	Hypersplenism
	Immune thrombocytopenia		Antibody-mediated platelet destruction						Moderate to severe	-																			Diagnosis of exclusion
	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
Infection-induced	Viral infections	rubella, mumps, varicella, parvovirus, hepatitis C, and Epstein-Barr virus
		HIV	Direct toxicity to megakaryocytes An ITP-like condition called primary HIV-associated thrombocytopenia (PHAT) Secondary opportunistic infections
	Bacterial infections	Sepsis	Direct bone marrow suppression	+
		Helicobacter pylori	Immune thrombocytopenia
		Leptospirosis, brucellosis, anaplasmosis, and other tick-borne infections
	Intracellular parasites	Malaria
		Babesiosis
Drug-induced	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
	Alcohol
	Malignancy
	Nutrient deficiencies	folate, vitamin B12, copper	an autoimmune mechanism						Mild
	Thrombotic microangiopathy (TMA)	Thrombotic thrombocytopenic purpura (TTP)
		Hemolytic uremic syndrome (HUS)
		Drug-induced TMA (DITMA)
Bone marrow disorders	Myelodysplastic syndromes
	Aplastic anemia
	Acute leukemia
	Paroxysmal nocturnal hemoglobinuria (PNH)
Rheumatologic/autoimmune disorders	Systemic lupus erythematosus (SLE)
	Antiphospholipid syndrome (APS)		autoantibody-mediated syndrome
	Felty's syndrome		splenomegaly
vascular	giant capillary hemangioma,		platelet destruction
	large aortic aneurysms,		platelet destruction
	cardiopulmonary bypass		platelet destruction
	Post-transfusion purpura		immune-mediated platelet destruction