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Causes of Thrombocytopenia (Impaired Production (Toxins - Chemotherapy…
Causes of Thrombocytopenia
Sequestration
Splenomegaly
Hypersplenism
Excessive Destruction or Consumption
Immune Mediated
AI - Immune Thrombocytopenic Purpura
Immune destruction of platelets.
Antibody coated platelets removed following binding to Fc receptors on macrophages.
ITP in Children
Most common 2-6 yrs old.
Mucocutaneous bleeding - brushing teeth, epistaxis, GI.
May be a history of recent viral infection - VZV, measles.
Bleeding may be severe, but life-threatening haemorrhage rare.
ITP in Adults
Less acute than in children.
Characteristically seen in women and may be associated with other AI disease - SLE, thyroid and AI haemolytic anaemia.
Also seen in patients with CLL and solid tumours and those with HIV.
Platelet autoantibodies found in 60-70% of patients. These usually have specificity for platelet membrane glycoproteins IIb/IIIa and/or Ib.
Clinical Features
Major haemorrhage rare - only seen in patients with severe thrombocytopenia.
Easy bruising, purpura, epistaxis and menorrhagia common.
Splenomegaly rare. Examination normal other than evidence of bleeding.
Investigations
Iatrogenic
DIC
TTP
Dilutional
Massive Transfusion
Impaired Production
Toxins - Chemotherapy & Radiotherapy
Infiltration
Systemic malignancies
Infections
Deficiencies - B12 & Folate
Haematological Malignancies
Leukaemia
Myeloma
Myelodysplasia
Fibrosis
Aplastic Anaemia
HIV Infection