Thrombocytopenia

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

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Thrombocytopenia, defined as a platelet count of <150 × 109/L (reference range varies depending on local laboratory standard), is caused by 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
Posttransfusion 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, ehrlichia, 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, defined as a platelet count of <150 × 109/L (reference range varies depending on local laboratory standard), is caused by 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
Posttransfusion 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, ehrlichia, 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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