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Causes of thrombocytopenia


Causes of thrombocytopenia

المعلومة

Causes of thrombocytopenia— PLATELETS
Platelet disorders: TTP, ITP, DIC
Leukemia
Anemia
Trauma
Enlarged spleen
Liver disease
EtOH
Toxins (benzene, heparin, aspirin, chemotherapy)
Sepsis
Petechiae suggest Platelet deficiency.

Bleeding into body Cavities or joints suggests Clotting factor deficiency.

المرجع

First Aid Step2 CK 5ed 2005-2006.
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Idiopathic Thrombocytopenic Purpura (ITP)
An autoimmune platelet disorder in which IgG autoantibody binds to platelets → lysis by splenic macrophages. Evans’ syndrome is ITP with autoimmune hemolytic anemia. Peak incidence is between 20 and 50 years of age, and the female-to-male ratio is 2:1.
HISTORY/PE
■ Presents in pediatric patients with acute onset following viral illness.
■ In adults, it has a gradual onset and typically follows viral infection, although it can also be drug related (e.g., sulfa drugs).
■ There are no systemic symptoms, and patients are generally afebrile (vs. TTP).
Mucosal or skin bleeding includes epistaxis, oral bleeding or hemorrhagic bullae, menorrhagia, and purpura or petechiae.
■ If splenomegaly is present, consider an alternative diagnosis].
DIAGNOSIS
■ A diagnosis of exclusion.
■ CBC shows thrombocytopenia (less than 150,000/μL) and possibly anemia.
■ PT and PTT are normal; bleeding time is prolonged; DIC panel is normal.
■  platelet-associated IgG test.
■ Peripheral blood smear reveals megathrombocytes without schistocytes.
■ Bone marrow aspiration is normal or shows ↑ egakaryocytes.
TREATMENT
■ Pediatric patients: The disease is self-limited, and 70% of patients recover in 4–6 weeks.
■ Adults:
■ Observation if platelet count more than 50,000/μL and the patient is asymptomatic.
■ Prednisone (may mask a leukemia masquerading as ITP, so consider bone marrow aspiration before treatment).
■ IV gamma globulin anti-Rho(D) (for Rh-+ patients) for life-threatening hemorrhage or severe thrombocytopenia ( less than10,000/μL).
■ Platelets should be given for severe, uncontrollable bleeding.
■ Splenectomy provides effective treatment for two-thirds of patients who are refractory to medical treatment.

Source : First Aid Step2 CK 5ed 2005-2006.

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