Thrombocytopenia

Thrombocytopenia is a topic covered in the Washington Manual of Medical Therapeutics.

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  • Thrombocytopenia is defined as a platelet count of <150 × 10/L (reference range varies depending on local laboratory standard).
  • Thrombocytopenia occurs from decreased production, increased destruction, or sequestration of platelets (Table 20-2).
    Table 20-2: Classification of Thrombocytopenia
    Decreased Platelet ProductionIncreased Platelet Clearance
    Marrow failure syndromes
    Congenital
    Acquired: Aplastic anemia, paroxysmal nocturnal hemoglobinuria
    Hematologic malignancies
    Marrow infiltration: Cancer, granuloma
    Myelofibrosis: Primary or secondary
    Nutritional: Vitamin B12 and folate deficiencies
    Physical damage to the bone marrow: Radiation, alcohol, chemotherapy    		Immune-mediated mechanisms
    Immune thrombocytopenic
    Thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome
    Post-transfusion purpura
    Heparin-induced thrombocytopenia
    Non–immune-mediated mechanisms
    DIC
    Local consumption (aortic aneurysm)
    Acute hemorrhage
    Increased Splenic SequestrationInfections Associated With Thrombocytopenia
    Portal hypertension
    Felty syndrome
    Lysosomal storage disorders
    Infiltrative hematologic malignancies
    Extramedullary hematopoiesis    		HIV, HHV-6, ehrlichiosis, rickettsia, malaria, hepatitis C, CMV, Epstein-Barr, Helicobacter pylori, Escherichia coli O157

    CMV, cytomegalovirus; DIC, disseminated intravascular coagulation; HHV-6, human herpesvirus 6.

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  • Thrombocytopenia is defined as a platelet count of <150 × 10/L (reference range varies depending on local laboratory standard).
  • Thrombocytopenia occurs from decreased production, increased destruction, or sequestration of platelets (Table 20-2).
    Table 20-2: Classification of Thrombocytopenia
    Decreased Platelet ProductionIncreased Platelet Clearance
    Marrow failure syndromes
    Congenital
    Acquired: Aplastic anemia, paroxysmal nocturnal hemoglobinuria
    Hematologic malignancies
    Marrow infiltration: Cancer, granuloma
    Myelofibrosis: Primary or secondary
    Nutritional: Vitamin B12 and folate deficiencies
    Physical damage to the bone marrow: Radiation, alcohol, chemotherapy    		Immune-mediated mechanisms
    Immune thrombocytopenic
    Thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome
    Post-transfusion purpura
    Heparin-induced thrombocytopenia
    Non–immune-mediated mechanisms
    DIC
    Local consumption (aortic aneurysm)
    Acute hemorrhage
    Increased Splenic SequestrationInfections Associated With Thrombocytopenia
    Portal hypertension
    Felty syndrome
    Lysosomal storage disorders
    Infiltrative hematologic malignancies
    Extramedullary hematopoiesis    		HIV, HHV-6, ehrlichiosis, rickettsia, malaria, hepatitis C, CMV, Epstein-Barr, Helicobacter pylori, Escherichia coli O157

    CMV, cytomegalovirus; DIC, disseminated intravascular coagulation; HHV-6, human herpesvirus 6.

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