THROMBOCYTOPENIA
THROMBOCYTOPENIA: Excerpt from Differential Diagnosis in Primary Care
The mnemonic VINDICATE is very useful to develop a list of causes of thrombocytopenia.
THROMBOCYTOPENIA
- V—Vascular should help the recall of 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 category will prompt the recall of thrombocytopenia associated with gold salts, alcohol, chemotherapy, chloramphenicol, phenylbutazone, radiation, thiazides, sulfonamides and quinidine.
- C—Congenital 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 While trauma does not directly induce thrombocytopenia, this category should help recall transfusion reactions and DIC.
- E—Endocrine category prompts the recall of hyperthyroidism and thyroiditis.
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 cause 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 disease, splenomegaly)
- Bone scan (metastasis)
- Platelet antibody titer (thrombocytopenia)
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- 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.
» Next page: Thrombocytopenia (A Pocket Manual of Differential Diagnosis)
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