Diagnosis of Thrombocytopenia
Thrombocytopenia Diagnosis: Book Excerpts
Diagnostic Tests for Thrombocytopenia: Online Medical Books
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THROMBOCYTOPENIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- What is the WBC count? Thrombocytopenia with a high white count suggests leukemia or myeloid metaplasia. Thrombocytopenia with a normal white count suggests idiopathic thrombocytopenic purpura or drug reaction. Thrombocytopenia with a low white count suggests lupus erythematosus, aplastic anemia, myelofibrosis, drugs, myelophthisic anemia, or pernicious anemia.
- What is the ANA? A positive ANA in the face of thrombocytopenia and a low white count suggests lupus erythematosus.
DIAGNOSTIC WORKUP
The diagnostic workup should include a CBC, blood smear, sedimentation rate, urinalysis, serum B
12
, chemistry panel, ANA, serum haptoglobins, red cell survival, liver spleen scan, CT scan of the abdomen, and a hematology consult for bone marrow study.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Thrombocytopenia:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
Disorders of increased destruction
- Immunologic platelet consumption
–Immune thrombocytopenic purpura (ITP)
–Drug-induced (antiepileptics, septra)
–Infection (EBV, CMV, malaria, Parvovirus, HIV, other viral illnesses)
–Autoimmune disease (SLE)
–Evans syndrome: ITP with immune
hemolytic anemia
–Allergy or anaphylaxis
–Posttransplant
-
Nonimmunologic
–Chronic microangiopathic hemolytic anemia
–Hemolytic-uremic syndrome (HUS)
–Thrombotic thrombocytopenic purpura
–Shear (catheters, cardiopulmonary bypass, congenital or acquired heart disease)
Disorders of decreased production
-
Bone marrow infiltration: Leukemia, neuroblastoma, histiocytosis, osteopetrosis
-
Marrow failure: Aplastic anemia, congenital microangiopathic anemia, thrombocytopenia with absent radii (TAR), Fanconi anemia, myelodysplasia, amegakaryocytic thrombocytopenia
-
Abnormal platelet size or morphology
–Bernard-Soulier
–May-Hegglin
–Gray platelet
–Wiskott-Aldrich
-
Severe nutritional deficiency
–B12, folate
Combined disorders
-
DIC, Kasabach-Merritt syndrome, storage diseases, renal disease, pre-eclampsia
Sequestration
-
Hypersplenism/portal hypertension, thrombosis, cavernous transformation of portal vein, hypothermia
Neonatal
-
Congenital anomalies (trisomy 13 or 18)
-
Maternal causes: ITP, SLE, HELLP syndrome, DIC, hyperthyroidism, viral illness, drug use
-
NEC
Workup and Diagnosis
-
History: Recent illness, diet history; bleeding (nose, gum, stool, urine, skin, duration, amount); bone pain, fever, lethargy or crankiness, limp; HIV risk factors, diet history; exposure to toxins or radiation
-
-
-
Medical history: Congenital anomalies; bleeding with previous surgery or trauma, menorrhagia; frequent infections, congenital cyanotic heart disease
-
Family history: Thrombocytopenia; autoimmune or collagen vascular diseases; blood dyscrasias, hematologic malignancies; storage diseases
-
Physical exam
–General appearance, growth
–Petechiae, purpura, ecchymoses, eczema, pallor
–Jaundice, nail dystrophy
–Lymph node chains
–Splenomegaly, hepatomegaly, bruit, masses
–Caput medusae or spider hemangiomas
–Palatal petechiae, gum bleeding, leukoplakia
–Absent radii, thumb anomalies, joint abnormalities
-
Studies
–Bone marrow exam
–Abdominal ultrasound; chest X-ray
-
Labs
–All patients: CBC/diff with peripheral smear
–Selected patients: direct and indirect Coombs, LDH,
DIC panel (PT/PTT, fibrinogen, D-dimers), blood culture, HIV, ANA, urinalysis, renal function, CMV and EBV titers, hepatitis B and C serologies
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
THROMBOCYTOPENIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
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.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Thrombocytopenia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis is based on the results of the patient history (especially a drug history), physical examination, and laboratory tests. Coagulation tests reveal a decreased platelet count (in adults, less than 100,000/µl), prolonged bleeding time, and normal prothrombin time and partial thromboplastin time. If increased destruction of platelets is causing thrombocytopenia, bone marrow studies will reveal a greater number of megakaryocytes (platelet precursors) and shortened platelet survival (several hours or days rather than the usual 7 to 10 days).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Thrombocytopenia:
Diagnosis
(Handbook of Diseases)
To diagnose thrombocytopenia, obtain a patient history (especially a drug history), a physical examination, and the following laboratory tests:
❑ Coagulation tests reveal a decreased platelet count (in adults, < 100,000/µl), prolonged bleeding time, and normal prothrombin time and partial thromboplastin time. Platelet-associated antibodies may be present.
❑ If increased destruction of platelets is causing thrombocytopenia, bone marrow studies will reveal a greater number of megakaryocytes (platelet precursors) and shortened platelet survival (several hours or days rather than the usual 7 to 10 days).
>
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
THROMBOCYTOPENIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
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.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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