Thrombocytopenia: Causes & Work-ups
Causes
There are three major causes of Thrombocytopenia. First, there is a decrease in bone marrow production. If there is a problem in bone narrow, factors such as BM failure, adverse effect of drug, and BM infiltration can be considered. The second is splenic sequestration by splenomegaly. One-third of the platelets usually pass through the liver and spleen, and splenomegaly can increase this amount, reducing the number of platelets in the peripheral blood. Liver cirrhosis, leukemia, splenic vein thrombosis, and portal hypertension may cause splenomegaly. Finally, when platelet destruction increases, thrombocytopenia may occur, which can be further divided into immune destruction and non-immune destruction. Immunologic thrombocytopenia is caused by the removal of monocytes from the spleen of the pletelets that bind the antibody, immune complexes, and complement. The most common cause is infection and autoimmune diseases such as drug, ITP and SLE can also be induced. Non-immunologic thrombocytopenia refers to the mechanical platelet destruction, including artificial valve, TTP, HUS, and DIC. In addition, it may occur immediately after massive transfusion and during pregnancy as the plasma volume increases and the platelet concentration decreases, which is very mild.
Work-ups
History, physical examination, CBC, and PB smears are essential procedures for diagnosing patients with thrombocytopenia. The current overall health status of the patient, the medication being used, or the treatment, have a significant impact on the differential diagnosis. It is also important whether the family has a history of thrombocytopenia-related illness or whether the patient has genetic predisposition related to the disease. Another important step is to preferentially exclude pseudo-thrombocytopenia through the PB smear. In the presence of neutrophil and platelet adhesion to the anticoagulant EDTA, platelet aggregation or platelet aggregation by the platelet activation molecule expressed on the neutrophil cell membrane when the inflammation is present, the platelet is read as one, so it can be read 100 times less than the actual have. If the number and symptoms of platelets are not consistent, and if it is confirmed to be a false positive through smear, touch the spleen through abdominal stimulation to check for splenomegaly and bone marrow study to check precise origin of production defect and excess destruction I have to find out.
There are three major causes of Thrombocytopenia. First, there is a decrease in bone marrow production. If there is a problem in bone narrow, factors such as BM failure, adverse effect of drug, and BM infiltration can be considered. The second is splenic sequestration by splenomegaly. One-third of the platelets usually pass through the liver and spleen, and splenomegaly can increase this amount, reducing the number of platelets in the peripheral blood. Liver cirrhosis, leukemia, splenic vein thrombosis, and portal hypertension may cause splenomegaly. Finally, when platelet destruction increases, thrombocytopenia may occur, which can be further divided into immune destruction and non-immune destruction. Immunologic thrombocytopenia is caused by the removal of monocytes from the spleen of the pletelets that bind the antibody, immune complexes, and complement. The most common cause is infection and autoimmune diseases such as drug, ITP and SLE can also be induced. Non-immunologic thrombocytopenia refers to the mechanical platelet destruction, including artificial valve, TTP, HUS, and DIC. In addition, it may occur immediately after massive transfusion and during pregnancy as the plasma volume increases and the platelet concentration decreases, which is very mild.
Work-ups
History, physical examination, CBC, and PB smears are essential procedures for diagnosing patients with thrombocytopenia. The current overall health status of the patient, the medication being used, or the treatment, have a significant impact on the differential diagnosis. It is also important whether the family has a history of thrombocytopenia-related illness or whether the patient has genetic predisposition related to the disease. Another important step is to preferentially exclude pseudo-thrombocytopenia through the PB smear. In the presence of neutrophil and platelet adhesion to the anticoagulant EDTA, platelet aggregation or platelet aggregation by the platelet activation molecule expressed on the neutrophil cell membrane when the inflammation is present, the platelet is read as one, so it can be read 100 times less than the actual have. If the number and symptoms of platelets are not consistent, and if it is confirmed to be a false positive through smear, touch the spleen through abdominal stimulation to check for splenomegaly and bone marrow study to check precise origin of production defect and excess destruction I have to find out.
