Differential Diagnosis for Low Platelets, High WBC with Neutrophils and Myelocytes, Increased Liver Enzymes, and Bilirubin

• Single Most Likely Diagnosis
  • Sepsis: This condition is characterized by a systemic inflammatory response to infection, which can lead to thrombocytopenia (low platelets) due to consumption, leukocytosis (high WBC) with a left shift (presence of myelocytes indicating immature cells being released from the bone marrow), elevated liver enzymes due to hypoperfusion or direct infection, and hyperbilirubinemia (elevated bilirubin) from decreased liver function or hemolysis.
• Other Likely Diagnoses
  • Hematologic Malignancies (e.g., Leukemia): Certain types of leukemia can cause an increase in WBC with the presence of immature cells like myelocytes, thrombocytopenia due to bone marrow infiltration, and liver enzyme elevation due to organ involvement. Hyperbilirubinemia can occur from hemolysis or liver dysfunction.
  • Severe Infections (e.g., Typhoid Fever, Malaria): These infections can cause thrombocytopenia, leukocytosis with a left shift, elevated liver enzymes, and hyperbilirubinemia due to the infection itself or associated complications like disseminated intravascular coagulation (DIC).
• Do Not Miss Diagnoses
  • Disseminated Intravascular Coagulation (DIC): A condition characterized by both widespread clotting and bleeding in the vascular system, which can lead to thrombocytopenia, elevated liver enzymes, and hyperbilirubinemia. It often occurs in the context of severe infection, trauma, or malignancy.
  • Thrombotic Thrombocytopenic Purpura (TTP): A rare disorder of the blood-coagulation system, causing extensive microscopic thrombi to form in the smallest blood vessels throughout the body. These thrombi consume platelets, leading to thrombocytopenia, and can cause elevated liver enzymes and bilirubin due to microangiopathic hemolytic anemia.
• Rare Diagnoses
  • Hemophagocytic Lymphohistiocytosis (HLH): A rare disorder of the immune system where it produces too many activated immune cells called macrophages and lymphocytes. These cells infiltrate various tissues and can cause thrombocytopenia, elevated liver enzymes, and hyperbilirubinemia.
  • Lymphoma with Hepatic Involvement: Certain lymphomas can infiltrate the liver, causing elevated liver enzymes and bilirubin, and also lead to thrombocytopenia and leukocytosis with a left shift due to bone marrow involvement or associated hematologic abnormalities.