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 Physical exam Laboratory findings Pathology Other specifics
WBC changes RBC changes other findings
Cardiovascular endocarditis[1] Skin

Oral Cavity

Eyes

Ear Nose and Throat

Cardiovascular

Lungs

Abdomen

Neurologic

+/↑ -
pulmonary embolism[2]
Chemical/poisoning Strontium-89
zinc
Dermatologic Cholesterol embolism
Griscelli syndrome
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
Fanconi anaemia
Fechtner syndrome
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
Nutritional/Metabolic 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 Eclampsiapre-eclampsia
HELLP syndrome
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 ethanol
arsenic trioxide
Pulmonary Acute respiratory distress syndrome
Renal/Electrolyte 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
systemic lupus erythematosus
Miscellaneous Snakebites

References

  1. Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis Accessed on September 24, 2015
  2. Cohen AT, Dobromirski M, Gurwith MM (2014). "Managing pulmonary embolism from presentation to extended treatment". Thromb Res. 133 (2): 139–48. doi:10.1016/j.thromres.2013.09.040. PMID 24182642.

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