From the Guidelines
Thrombocytopenia is primarily caused by decreased platelet production, increased platelet destruction, or splenic sequestration, with common causes including idiopathic thrombocytopenic purpura (ITP), drug-induced thrombocytopenia, and infections such as HIV or bacteremia 1. The evaluation of thrombocytopenia should distinguish between true thrombocytopenia and pseudothrombocytopenia, which occurs in about 0.1% of adults, most commonly due to innocent platelet agglutinins that cause platelet clumping in the presence of the anticoagulant EDTA 1. Some key causes of thrombocytopenia include:
- Idiopathic thrombocytopenic purpura (ITP)
- Drug-induced thrombocytopenia, with drugs such as quinidine, heparin, sulfonamides, sulfonylureas, dipyridamole, and salicylates
- Infections, including HIV, bacteremia, and viral infections
- Chronic liver disease and platelet pooling
- Alcohol consumption
- Autoimmune disorders, such as arthritis, goiter, nephritis, or cutaneous vasculitis
- Lymphoproliferative disorders
- Congenital thrombocytopenia It is essential to consider the patient's lifestyle, medical history, and physical examination findings to determine the underlying cause of thrombocytopenia and guide treatment decisions 1. A thorough history and physical examination, including assessment of bleeding symptoms and signs, are crucial in evaluating thrombocytopenia and guiding further diagnostic testing and treatment 1.
From the Research
Causes of Thrombocytopenia
Thrombocytopenia, a condition characterized by a low platelet count, can result from various causes, including:
- Decreased platelet production 2, 3, 4, 5
- Increased destruction of platelets 2, 3, 4, 5
- Splenic sequestration 2
- Dilution or clumping of platelets 2
- Pseudothrombocytopenia 2, 3, 5
- Hemodilution 3
- Increased consumption of platelets 3
- Immune-mediated destruction of platelets 3
- Drug-induced thrombocytopenia 2, 3, 5
- Immune thrombocytopenia 2, 3, 5
- Hepatic disease 2, 5
- Sepsis 3
- Trauma 3
- Heparin-induced thrombocytopenia 2, 3, 5
- Thrombotic microangiopathies 2, 4, 5
- Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome 2, 5
- Gestational thrombocytopenia 5
- Disseminated intravascular coagulation 5
- Antiphospholipid syndrome 2
Emergency Causes of Thrombocytopenia
Emergency causes of thrombocytopenia that require immediate hospitalization include:
- Heparin-induced thrombocytopenia 2, 3
- Thrombotic microangiopathies 2, 4, 5
- HELLP syndrome 2, 5
- Active bleeding 3, 6
- Biological signs of disseminated intravascular coagulation 6
- Acute renal failure 6
- Platelet count < 30 G/l (or < 50 G/l if the patient is on anticoagulation or antiplatelet therapy) 6
- Significant and/or brutal onset pancytopenia 6