Podcast: Play in new window | Download

Clinical Presentation

  • Incidental finding on routing CBC
  • Petechiae/purpura
  • Mucosal bleeding
  • Epistaxis
  • Gingival bleeding
  • Hematuria
  • Vaginal bleeding

5 Major Causes of Thrombocytopenia

  • Thrombotic Thrombocytopenic Purpura (TTP)
    • Clinical presentation (pentad)
      • Thrombocytopenia
      • Fever
      • Microangiopathic hemolytic anemia
        • “schistocytes”
      • Neurologic abnormalities
      • Renal dysfunction
    • Physiology
      • Low ADAMTS13 results in impaired vWF breakdown
        • Widespread “platelet plugs”
    • Treatment
      • Plasma exchange
  • Hemolytic Uremic Syndrome (HUS)
    • Clinical presentation
      • Pediatric patient with bloody diarrhea
      • Renal dysfunction
      • Thrombocytopenia
    • Treatment
      • Supportive care
  • Heparin Induced Thrombocytopenia (HIT)
    • Clinical presentation
      • Recent heparin administration
      • Acute thrombocytopenia (<150) or 50% decrease in platelets
    • Treatment
      • Stop heparin and choose different anticoagulant
  • Disseminated Intravascular Coagulation (DIC)
    • Clinical presentation
      • Patient septic, severe trauma, or otherwise critically ill/injured
      • Multiple abnormal labs
        • Increased PT/PTT
        • Increased D-dimer
        • Increased fibrinogen degradation products
    • Treat underlying trigger
  • Immune/Idiopathic Thrombocytopenic Purpura (ITP)
  • Common condition
    • Relatively benign
  • Treatment
    • Steroids
    • Occasionally platelet transfusion
  • Other causes
    • HIV
    • Hepatitis
    • Heavy alcohol use

Additional Reading

  • Thrombocytopenia: An ED Approach (emDOCs)