From the Guidelines
Thrombocytopenia is primarily caused by decreased platelet production, increased platelet destruction, or splenic sequestration, with immune thrombocytopenia (ITP) being a common autoimmune disorder characterized by low platelet count due to platelet destruction and impaired production 1.
Causes of Thrombocytopenia
The causes of thrombocytopenia can be broadly categorized into:
- Decreased platelet production, which can be due to bone marrow failure, vitamin deficiencies, or certain medications
- Increased platelet destruction, which can be caused by immune system disorders such as ITP, infections, or certain medications
- Splenic sequestration, which can occur due to splenomegaly or other conditions that affect the spleen Some specific causes of thrombocytopenia include:
- Idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disorder that causes the immune system to attack and destroy platelets 1
- Infections such as HIV, hepatitis, or sepsis, which can cause thrombocytopenia due to increased platelet destruction or decreased production
- Medications such as heparin, quinidine, or sulfonamides, which can cause thrombocytopenia as a side effect
- Chronic liver disease or cirrhosis, which can cause splenic sequestration and thrombocytopenia
- Bone marrow failure or disorders such as leukemia or lymphoma, which can cause decreased platelet production
Diagnosis and Evaluation
The evaluation of thrombocytopenia should distinguish between true thrombocytopenia and pseudothrombocytopenia, which occurs in about 0.1% of adults due to innocent platelet agglutinins that cause platelet clumping in the presence of the anticoagulant EDTA 1. A thorough history and physical examination, including assessment of bleeding symptoms and signs, should be performed to identify potential causes of thrombocytopenia. Laboratory tests, such as complete blood counts and blood smears, should be used to confirm the diagnosis and rule out other conditions.
Management and Treatment
The management and treatment of thrombocytopenia depend on the underlying cause, severity, and symptoms. For mild cases, observation may be sufficient, while for moderate to severe cases, addressing the underlying cause is essential. First-line treatment for ITP typically includes corticosteroids or high-dose dexamethasone, while second-line options include thrombopoietin receptor agonists, rituximab, or splenectomy 1. Patients should avoid medications that affect platelet function, minimize injury risk, and recognize bleeding signs.
From the Research
Causes of Thrombocytopenia
Thrombocytopenia, a condition characterized by a low platelet count, can result from various causes. The main causes include:
- Decreased platelet production 2
- Increased destruction of platelets 2, 3, 4
- Splenic sequestration 2
- Dilution or clumping of platelets 2
Specific Causes
Some specific causes of thrombocytopenia include:
- Immune thrombocytopenia 2, 4, 5
- Drug-induced thrombocytopenia 2, 4
- Hepatic disease 2, 4
- Heparin-induced thrombocytopenia 2, 6
- Thrombotic microangiopathies 2, 3, 4
- Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome 2, 4
- Infections such as HIV and hepatitis C virus 3
- Preeclampsia and gestational thrombocytopenia during pregnancy 4
- Sepsis and trauma in intensive care unit patients 6
Mechanisms
The mechanisms underlying thrombocytopenia can be complex and involve various pathways, including: