Thrombocytopenia is traditionally taught with distinguishing between a bone marrow disorder, ruling out splenic sequestration, or peripheral destruction.
Discussion points: Discuss the differential diagnosis of thrombocytopenia.
Decreased production:
- Congenital bone marrow disorders (TAR, Fanconi’s)
- Aplasia (chemotherapy, radiation, alcohol, medications)
- Infiltration
- Hereditary disorders (May Hegglin, Bernard Soulier)
- Nutritional deficiencies (n.b. – it can take 2 weeks for platelets to return to normal levels following replacement)
Distribution:
- Splenomegaly (30% of plts are stored in the spleen)
- Hypothermia
- Dilution post massive transfusion
Destruction:
- Immune mediated destruction (drug induced and chronic/acute immune thrombocytopenia)
- Consumption (TTP, DIC, TTP, HUS, HELLP)
