Thrombocytopenia: Difference between revisions
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==Background== | ==Background== | ||
Thrombocytopenia is best grouped into a few main categories. The following lists helps organize workup and differential. | Thrombocytopenia is best grouped into a few main categories. The following lists helps organize workup and differential. | ||
==Clinical Features== | ==Clinical Features== |
Revision as of 22:49, 17 October 2015
Background
Thrombocytopenia is best grouped into a few main categories. The following lists helps organize workup and differential.
Clinical Features
- Nonpalpable petechiae/purpura
- Mucosal bleeding (gingival, epistaxis)
- Menorrhagia, hemoptysis, hematuria, hematochezia
- Deep tissue/joint bleeding is less common (more likely due to coagulopathies)
Differential Diagnosis
Thrombocytopenia
Decreased production
- Marrow infiltration (tumor or infection)
- Viral infections (rubella, HIV)
- Marrow suppression (commonly chemotherapy or radiation)
- Congenital thrombocytopenia
- Fanconi anemia
- Alport syndrome
- Bernand Soulier
- Vitamin B12 and/or folate deficiency
Increased platelet destruction or use
- Idiopathic thrombocytopenic purpura
- Thrombotic Thrombocytopenic Purpura (TTP)
- Hemolytic Uremic Syndrome (HUS)
- Disseminated Intravascular Coagulation (DIC)
- Viral infections (HIV, mumps, varicella, EBV)
- Drugs (heparin, protamine)
- Postransfusion or Posttransplantation
- Autoimmune destruction (SLE or Sarcoidosis)
- Mechanical destruction
- Artificial valves
- ECMO
- HELLP syndrome
- Excessive hemorrhage
- Hemodialysis, extracorporeal circulation
- Splenic Sequestration
- Occurs in Sickle cell disease and Cirrhosis
Drug Induced
- sulfa antibiotics, ETOH, ASA, thiazide diuretics/furosemide
Comparison by Etiology
ITP | TTP | HUS | HIT | DIC | |
---|---|---|---|---|---|
↓ PLT | Yes | Yes | Yes | Yes | Yes |
↑PT/INR | No | No | No | +/- | Yes |
MAHA | No | Yes | Yes | No | Yes |
↓ Fibrinogen | No | No | No | No | Yes |
Ok to give PLT | Yes | No | No | No | Yes |
Bleeding Specific Differential Diagnosis
Coagulopathy
Platelet Related
- Too few
- Nonfunctional
Factor Related
- Acquired (Drug Related)
- Warfarin (Coumadin)
- Unfractionated heparin
- Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
- Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
- Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
- Illness induced
- Genetic
Diagnosis
- Platelet count (CBC)
Treatment
Platelet Transfusion Thresholds
most if not all of the following thresholds are based on weak recommendations with low quality evidence[1]
- <50K if planned lumbar puncture or neurosurgical procedure[2]
- <20K if planned for central venous catheter placement (preference toward compressible site), or febrile patient
- <10K in asymptomatic patients (unless due to ITP, TTP, or HIT)
There are no firm recommendations for transfusion thresholds in acute traumatic bleeding but many providers will opt for a goal of 100K, especially if there is evidence of ICH
Transfusion contraindications
- TTP, DIC, HIT
Pediatrics
- 1 unit of platelets per 5kg body weight raises count by 50k