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Thrombocytopenia (Common causes of thrombocytopenia (Drug-induced immune…
Thrombocytopenia
Common causes of thrombocytopenia
Primary immune thrombocytopenia (ITP)
Drug-induced immune thrombocytopenia (DITP)
Heparin
(NOTE: special case, also can cause thrombosis)
Quinine
(as in over-the-counter tablets for leg cramps; also in beverages)
Sulfonamides
(eg, trimethoprim-sulfamethoxazole [Bactrim; Septra])
Acetaminophen
(Tylenol, Panadol)
Ibuprofen
Naproxen
Ampicillin
Piperacillin
Vancomycin (Vancocin)
Glycoprotein IIb/IIIa inhibitors (abciximab [ReoPro], tirofiban [Aggrastat], eptifibatide [Integrilin])
Infections
HIV
Hepatitis C
Epstein-Barr virus
Helicobacter pylori
(suspected in patients with symptoms of dyspepsia or peptic ulcer disease)
Sepsis with disseminated intravascular coagulation (DIC)
Intracellular parasites (eg, malaria)
Others
Hypersplenism
due to chronic liver disease
Alcohol
Nutrient deficiencies
(eg, vitamin B12, folate, copper)
Rheumatologic/autoimmune disorders (eg, systemic lupus erythematosus, rheumatoid arthritis)
Pregnancy
Gestational thrombocytopenia
Preeclampsia
HELLP syndrome (hemolysis, elevated liver function tests, low platelets)
Approach to thrombocytopenia
Is it real?
Is it new or old and whats rate of falling?
Is my patient symptomatic?
Is my patient at risk of bleeding/ thrombosis?
Mechanisms of thrombocytopenia
Decrease in production
Increased destruction
Are they hiding somewhere?
Uncommon causes of thrombocytopenia
Myelodysplasia
Cancer with disseminated intravascular coagulation
Cancer with bone marrow infiltration or suppression (eg, lymphoma, leukemia, some solid tumors)
Paroxysmal nocturnal hemoglobinuria (PNH)
Thrombotic microangiopathy (TMA)
Thrombotic thrombocytopenic purpura (TTP) is manifested by thrombocytopenia and microangiopathic hemolytic anemia; fever, renal failure, and/or neurologic symptoms may or may not be present
Hemolytic uremic syndrome (HUS) is typically seen in children following infection with a Shiga-toxin producing organism (Escherichia coli or Shigella)
Drug-induced TMA may occur with quinine, certain cancer therapies, calcineurin inhibitors, and others
Antiphospholipid syndrome (APS)
Aplastic anemia