Presentation
Provide a differential diagnosis of neonatal thrombocytopenia and describe the clinical presentation and management of the most common forms. [pedsinreview.aappublications.org]
Diagnosis Thrombocytopenia is diagnosed by having a blood sample taken and counting the platelets present in the sample. However, accurately determining the medical reason for this conditions is complex. [medical-dictionary.thefreedictionary.com]
BACKGROUND: The present study reports a case of piperacillin-induced thrombocytopenia in a dual heart and kidney transplant patient on January 28, 2016 (taking mycophenolate mofetil and tacrolimus). [ncbi.nlm.nih.gov]
Entire Body System
- Fever
[…] and severe fever with thrombocytopenia syndrome—conditions that can cause fever, vomiting and multiple organ failure. — Melinda Wenner Moyer, Scientific American, "Tick Discovery Highlights How Few Answers We Have about These Bugs in the U.S.," 26 June [merriam-webster.com]
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. Haemophysalis longicornis ticks have been considered the vector of severe fever with thrombocytopenia syndrome virus (SFTSV). [ncbi.nlm.nih.gov]
- Sepsis
INTRODUCTION: The pathogenesis of thrombocytopenia in patients with sepsis is not fully understood. [ncbi.nlm.nih.gov]
"Early-onset Pseudomonas aeruginosa sepsis and Yersinia enterocolitica neonatal infection: a unique combination in a preterm infant". European Journal of Pediatrics. 146 (2): 192–93. doi:10.1007/BF02343233. [en.wikipedia.org]
[…] or intrauterine growth restriction) combined with platelet consumption (during sepsis or NEC). [fn.bmj.com]
- Gaucher Disease
The most common causes of splenomegaly (enlarged spleen) are portal hypertension secondary to liver disease and splenic infiltration with tumor cells, or with macrophages in storage disorders (like Gaucher's disease ). [healthcentral.com]
disease Platelets become diluted Massive red blood cell replacement or exchange transfusion; stored red blood cells do not contain very many platelets Use or destruction of platelets increases Immune thrombocytopenia HIV infection and other viral infections [msdmanuals.com]
" - http://www.gastromd.com/lft.html Abnormalities in the spleen, such as cancer, cirrhosis, or Gaucher's disease, may cause abnormal amounts of platelets to be taken up by the spleen, which under normal conditions contains about one-third of the platelets [lymphomation.org]
- Surgical Procedure
A splenectomy is the surgical procedure that partially or completely removes the spleen. Indications [ edit ] The spleen, similar in structure to a large lymph node, acts as a blood filter. [en.wikipedia.org]
Figure 1 shows the clinical course of a representative case of vancomycin-induced thrombocytopenia in a 69-year-old woman with staphylococcal osteomyelitis after a surgical procedure. [nejm.org]
Clinical context - Surgical patients: Dilutional thrombocytopenia is mild and expected in the first 1-4 days following major surgical procedures. - Intensive care unit (ICU) patients: Thrombocytopenia in critically ill patients is often multifactorial [oncologynurseadvisor.com]
- Short Stature
Regional investigations may provide suggestions for preventing short stature... [read.qxmd.com]
Skeletal abnormalities: short stature, malformations of the thumbs and forearms seen in Fanconi anemia patients, thrombocytopenia-absent radii (TAR-syndrome) characterized by bilateral shortened or absent radii, thumb abnormalities [11]. [ncbi.nlm.nih.gov]
Hematological
- Easy Bruising
It may result in easy bruising and excessive bleeding from wounds or bleeding in mucous membranes and other tissues. [fpnotebook.com]
It may result in easy bruising and excessive bleeding from wounds or bleeding in mucous membranes and other tissues A condition in which there is an abnormally small number of platelets in the circulating blood A decrease in the number of platelets in [icd9data.com]
Thrombocytopenia is characterized by easy bruising and increased bleeding. [rxlist.com]
Other symptoms include nosebleeds and easy bruising; sometimes gastrointestinal bleeding, excess menstrual bleeding, or other hemorrhage is observed. Hemorrhage in the brain can have serious consequences. [britannica.com]
Gastrointestinal
- Hematemesis
Hemoptysis, hematemesis, hematuria, hematochezia, and melena are rarely the initial symptoms of a bleeding disorder. However, these may be exacerbated by an underlying bleeding disorder. Menstrual history is important. [emedicine.medscape.com]
Jaw & Teeth
- Bleeding Gums
With a low platelet count, you bleed easily You may have tiny purple spots on your skin and get nosebleeds and bleeding gums A very low platelet count may cause bleeding in your brain or severe bleeding from your intestines Many things can cause a low [msdmanuals.com]
Patients may notice petechiae or mucosal bleeding (e.g., bleeding gums, epistaxis) at lower platelet counts. Other patients with thrombocytopenia are clinically ill and have multisystem findings (e.g., acute infection, liver disease, TTP/HUS, DIC). [amboss.com]
Platelets help stop bleeding. So, a decrease in platelets can result in easy bruising, bleeding gums, and bleeding inside the body. The lower the platelet count, the greater the risk of bleeding. [stanfordchildrens.org]
People with thrombocytopenia can: bruise easily have nose bleeds or bleeding gums have pinpoint bleeding in the skin that looks like a rash (known as petechiae) have cuts that keep bleeding feel tired In rare cases, dangerous internal bleeding may occur [healthdirect.gov.au]
Skin
- Purpura
Describe the usual presentation and laboratory tests in the child who has acute idiopathic thrombocytopenic purpura, review the treatments, and know the usual prognosis. [pedsinreview.aappublications.org]
PMID 22314603. ^ "How Is Thrombotic Thrombocytopenic Purpura Treated? - NHLBI, NIH". www.nhlbi.nih.gov. Retrieved 2015-05-20. ^ Thrombocytopenic Purpura: New Insights for the Healthcare Professional: 2013 Edition: ScholarlyPaper. [en.wikipedia.org]
Thrombocytopenic, Idiopathic/diagnosis Purpura, Thrombocytopenic, Idiopathic/drug therapy Purpura, Thrombocytopenic, Idiopathic/etiology* Purpura, Thrombocytopenic, Idiopathic/metabolism* Signal Transduction*/drug effects Smad Proteins/genetics Smad [ncbi.nlm.nih.gov]
Increased destruction of platelets can be caused by infections, certain drugs, transfusion-related purpuras, idiopathic thrombocytopenic purpura, and disseminated intravascular coagulation. adj., adj thrombocytope´nic. Patient Care. [medical-dictionary.thefreedictionary.com]
- Petechiae
Findings on his physical examination are normal except for scattered crops of petechiae and multiple bruises. There is no active bleeding from the nose or other sites. [pedsinreview.aappublications.org]
Larger than petechiae, ecchymoses are purple, blue or yellow-green areas of skin that vary in size and shape. [en.wikipedia.org]
Painless, round and pinpoints (1 to 3 mm in diameter), petechiae usually appear and fade, and sometimes group to form ecchymoses. [healthcentral.com]
Suspect ITP in a child with thrombocytopenia and petechiae following a viral illness! [amboss.com]
- Ulcer
The anemia was secondary to chronic blood loss due to ulceration at the site of an ileocolonic anastomosis performed during infancy. [ncbi.nlm.nih.gov]
[…] with hemorrhage ( K26.0 ) acute gastritis with bleeding ( K29.01 ) ulcerative enterocolitis with rectal bleeding ( K51.01 ) purpura D69.3 (primary) Purpura D69.2 ICD-10-CM Diagnosis Code D69.2 Other nonthrombocytopenic purpura 2016 2017 2018 2019 Billable [icd10data.com]
Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; i: 1311-14. [ Links ] 2. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002; 347: 1175-86. [ Links ] 3. [scielo.org.mx]
One day after the patient's illness resolved, petechiae and bloody ulcers developed on his tongue and buccal mucosa ( Supplementary Figure 2 ). A day later he presented to a hospital emergency room. [academic.oup.com]
[…] be caused by inherited immune disorders (such as autoimmune lymphoproliferative syndrome, ALPS), systemic autoimmunity such as systemic lupus (the body attacks other cells as well as platelets), ongoing infections (such as HIV, Hepatitis C, and the ulcer-causing [rarediseases.org]
Face, Head & Neck
- Epistaxis
The patient was admitted to hematology service with epistaxis, ecchymoses, fever, thrombocytopenia (0.6 x 103/μL) and anemia. His initial diagnosis was idiopathic thrombocytopenic purpura. [ncbi.nlm.nih.gov]
Patients may notice petechiae or mucosal bleeding (e.g., bleeding gums, epistaxis) at lower platelet counts. Other patients with thrombocytopenia are clinically ill and have multisystem findings (e.g., acute infection, liver disease, TTP/HUS, DIC). [amboss.com]
It presents in infancy or in neonates (in severe cases) with patients bruising easily along with further manifestations of thrombocytopenia including epistaxis, petechiae, ecchymoses, or splenomegaly. [enerca.org]
Clinical Features Nonpalpable petechiae/purpura Mucosal bleeding (gingival, epistaxis) Menorrhagia, hemoptysis, hematuria, hematochezia Deep tissue/joint bleeding is less common (more likely due to coagulopathies) Differential Diagnosis Differential Diagnosis [wikem.org]
Thrombocytopenia: A look at the numbers Thrombocytopenia is defined as a platelet count <150,000/mcL.1 The blood abnormality is either suspected based on the patient’s signs or symptoms, such as ecchymoses, petechiae, purpura, epistaxis, gingival bleeding [mdedge.com]
Neurologic
- Somnolence
[…] ankles in ambulatory patients or on the back in bedridden ones suggest mild thrombocytopenia and a relatively low risk for a serious bleeding complication Findings suggestive of intracranial hemorrhage include the following: Headache, blurred vision, somnolence [emedicine.medscape.com]
- Guillain-Barré Syndrome
Most ZIKV infections are asymptomatic or result in only mild disease [ 4 ]; however, Guillain-Barré syndrome and congenital infection leading to severe birth defects, including microcephaly, may result in fatal outcomes [ 4 ]. [academic.oup.com]
The illness is usually self-limiting, and serious complications (such as hemolysis, Guillain-Barré syndrome, granulomatous hepatitis, carditis, pneumonia, meningoencephalitis, and thrombocytopenia) are rare. [journals.lww.com]
- Lethargy
All three affected siblings presented with SLE before the age of 3-years with lethargy, intermittent fever, thrombocytopenia, cutaneous involvement, alopecia, and hepatosplenomegaly. [ncbi.nlm.nih.gov]
(aPTT) ⇔ ⇔ ↑ or ⇔ Fibrinogen ⇔ ⇔ ↓ or ⇔ BUN/creatinine ↑ ↑ ↑ ↑ ↑ or ⇔ Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ⇔ ⇔ ↑ Lactate dehydrogenase (LDH) ↑ ↑ ↑ ↑ ↑ Clinical manifestations Presenting symptoms are often nonspecific (eg, lethargy [emedicine.medscape.com]
- Asthenia
[…] with placebo) Fatigue: 25% (vs 21% with placebo) Influenza‐like illness: 20% (vs 14% with placebo) Headache: 19% (vs 20% with placebo) Diarrhoea: 19% (vs 10% with placebo) Decreased appetite: 19% (vs 15% with placebo) Nausea: 18% (vs 15% with placebo) Asthenia [onlinelibrary.wiley.com]
Workup
Other laboratory tests should be obtained based on the initial workup and history. [clinicaladvisor.com]
Disseminated Intravascular Coagulation (DIC) Liver disease induced coagulopathy Uremic bleeding syndrome Genetic Hemophilia Factor VIII inhibitor Lupus anticoagulant Evaluation Algorithm for the Evaluation of Thrombocytopenia Platelet count (CBC) Additional workup [wikem.org]
It is not still clear if detection of H. pylori infection should be routinely included in the initial workup of chronic thrombocytopenia. Key words. H. pylori. Thrombocytopenia. Purpura. Mexico. [scielo.org.mx]
Evaluation begins with risk-stratification using the 4T score.2 interpretation of the 4T score: 0-3 points: Low probability (<<1%) No further workup of HITT is indicated (avoid checking heparin-PF4 antibodies). 4-5 points: Intermediate probability (~10% [emcrit.org]
Serum
- Decreased Platelet Count
Clinically, we don’t care about thrombocytopenia until the platelet count decrease to 50,000 or below. [youtube.com]
Her platelet count decreased to 41 × 10/L, but was stable at ∼30 × 10/L for 3 months with platelet transfusion independency for 12 months. Both patients had no adverse effects with eltrombopag. [ncbi.nlm.nih.gov]
In addition to a complete medical history and physical examination, laboratory testing of the blood can show decreased platelet counts. [chop.edu]
Treatment
Treatment focuses on eliminating the underlying problem, whether that means discontinuing drugs suspected to cause it or treating underlying sepsis. Diagnosis and treatment of serious thrombocytopenia is usually directed by a hematologist. [en.wikipedia.org]
Therefore, warfarin treatment was replaced with dabigatran (300 mg/day). Her platelet count decreased (41,000/μL) significantly and dabigatran treatment was discontinued. [ncbi.nlm.nih.gov]
Treatment with IV immune globulin (IVIG) is usually successful. [merckmanuals.com]
Prognosis
Early confirmation and treatment may improve the prognosis. [ncbi.nlm.nih.gov]
Describe the usual presentation and laboratory tests in the child who has acute idiopathic thrombocytopenic purpura, review the treatments, and know the usual prognosis. [pedsinreview.aappublications.org]
Etiology
Additional etiologies include hereditary syndromes, such as Wiskott-Aldrich syndrome and Alport syndrome. [amboss.com]
The etiology can be anticipated by the history. [oncologynurseadvisor.com]
Common Etiologies of Thrombocytopenia with Clinical Findings and Suggested Treatment Etiology Severity Clinical presentation Evaluation Treatment Comments Bone marrow suppression by irradiation, chemotherapy, or neoplasia Moderate to severe History of [aafp.org]
On further work up we found a coexistent autoimmune etiology. Thrombocytopenia promptly responded to steroids, a cost effective option. [ncbi.nlm.nih.gov]
Epidemiology
Author information 1 State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dongda Street, Fengtai District, 100071, Beijing, PR China. 2 Treatment and Research Centre for Infectious Diseases, The 302 [ncbi.nlm.nih.gov]
Pathophysiology
Therefore, a review of the pathophysiology, differential diagnosis, and management of thrombocytopenia is in order. [pedsinreview.aappublications.org]
Platelet kinetic studies have been performed to determine the pathophysiologic mechanisms in various thrombocytopenic states, particularly in complicated clinical situations. [accessmedicine.mhmedical.com]
In addition, both siblings presented with drastic abnormalities in the B-cell compartment, which led to broad investigations for an immune-deficiency syndrome and provided a novel pathophysiologic hypothesis. [ncbi.nlm.nih.gov]
Prevention
CONCLUSIONS: Dabigatran application may cause bleeding; therefore, careful monitoring during dabigatran treatment is required to prevent thrombocytopenia. [ncbi.nlm.nih.gov]
The main goal of treatment is to prevent death and disability caused by bleeding. If your condition is mild, you may not need treatment. A fully normal platelet count isn't necessary to prevent bleeding, even with severe cuts or accidents. [hoacny.com]
Prevention There is no known way to prevent hrombocytopenia. Resources Organizations American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org. [medical-dictionary.thefreedictionary.com]