THROMBOCYTOPENIA
THROMBOCYTOPENIA: Excerpt from Differential Diagnosis in Primary Care
The mnemonic VINDICATE is very useful to develop a list of
causes of thrombocytopenia.
V—Vascular disorders should help
the recall of disseminated intravascular coagulation (DIC).
I—Inflammation. Infectious diseases that may be associated with
thrombocytopenia include malaria, rickettsia, toxic shock syndrome, typhoid
fever, cytomegalovirus (CMV), and septicemia.
N—Neoplasms that may be associated with thrombocytopenia include
leukemia, lymphoma, and myeloma; however, any tumor that may invade the bone
marrow can cause thrombocytopenia.
D—Deficiency disorders include vitamin B12 and folic acid
deficiencies.
I—Intoxication. This category will prompt the recall of
thrombocytopenia associated with gold salts, alcohol, chemotherapy,
chloramphenicol, phenylbutazone, radiation, thiazides, sulfonamides, and
quinidine.
C—Congenital. This category promotes the recall of
Wiskott–Aldrich syndrome, Fanconi anemia, maternal drug ingestion, and
congenital viral infections.
A—Autoimmune. The most important disorders brought to mind by
this category are idiopathic autoimmune thrombocytopenia purpura and
collagen diseases.
T—Trauma. Although trauma does not directly induce
thrombocytopenia, this category should help to recall transfusion reactions
and DIC.
E—Endocrine. This category prompts the recall of hyperthyroidism
and thyroiditis.
TINNITUS AND DEAFNESS
|
| V | I | N | D |
|
| Vascular | Inflammatory | Neoplasm | Degenerative |
|
| | | | |
|
External Canal |
|
Otitis externa |
Papilloma | |
| |
Middle Ear |
|
Otitis media |
|
Otosclerosis |
Inner Ear |
Spasm of internal auditory artery (migraine) |
Petrositis Labyrinthitis or cochleitis |
Cholesteatoma |
Senile deafness Ménière disease |
| |
| |
Acoustic Nerve |
Aneurysm |
|
Acoustic neuroma | |
| |
Brainstem |
Basilar artery insufficiency and occlusion |
Syphilis Viral encephalitis
| Glioma Meningioma
| Syringomyelia |
|
Approach to the Diagnosis
The laboratory workup will provide the best means of diagnosing the
cause of thrombocytopenia. If there is pancytopenia, the most likely cause
is aplastic anemia or bone marrow invasion. Collagen disorders such as lupus
erythematosus would paint a similar picture. If only the platelets are
affected, autoimmune disorders would be more likely the cause. The initial
workup should include a CBC, blood smear for morphology, sedimentation rate,
serum B12 and folic acid levels, chemistry panel, ANA, serum
haptoglobins, red cell survival, and protein electrophoresis. A hematologist
should be consulted.
Other Useful Tests
-
Bone marrow examination (aplastic anemia)
-
Liver–spleen scan (splenomegaly, disease of the spleen)
-
CT scan of the abdomen (neoplasm, Hodgkin lymphoma,
splenomegaly)
-
Bone scan (metastasis)
-
Platelet antibody titer (thrombocytopenia)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Thrombocytopenia
More Medical Textbooks Online about Thrombocytopenia
Review other book chapters online related to Thrombocytopenia:
Medical Books Excerpts
- Thrombocytopenia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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