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Thrombocytopenia Differential Diagnosis

Differentiating the diseases that can cause thrombocytopenia:

Category Condition Mechanism Clinical manifestations Para−clinical findings Gold standard Associated findings
Symptoms Signs
Lab Findings Imaging
Severity Fever Bleeding BP Other CBC PBS Coagulopathy
Infectious diseases Gestational thrombocytopenia
Chronic liver disease
portal hypertension
Hypersplenism
Immune thrombocytopenia Antibody-mediated platelet destruction Moderate to severe - Diagnosis of exclusion
Congenital platelet disorders MYH-9 related disorders
Bernard-Soulier syndrome
Gray platelet syndrome
Wiskott-Aldrich syndrome
Thrombocytopenia with absent radius (TAR) syndrome
Alport syndrome
Von Willebrand disease
Infection Viral infections rubella, mumps, varicella, parvovirus, hepatitis C, and Epstein-Barr virus
HIV
  • Direct toxicity to megakaryocytes
  • An ITP-like condition called primary HIV-associated thrombocytopenia (PHAT)
  • Secondary opportunistic infections
Bacterial infections Sepsis Direct bone marrow suppression
Helicobacter pylori Immune thrombocytopenia
leptospirosis, brucellosis, anaplasmosis, and other tick-borne infections
Intracellular parasites Malaria
Babesiosis
Medications/toxicity Drug-induced immune thrombocytopenia
  • Antibiotics
    • Sulfonamides
    • Ampicillin
    • Piperacillin
    • Vancomycin
    • Rifampin
  • Older antiepileptic agents
    • carbamazepine
    • Phenytoin
  • Quinine
Occurrence of drug-dependent, platelet-reactive antibodies
Heparin-induced thrombocytopenia
Cytotoxic chemotherapy
Radiation therapy Predictable, dose-dependent myelosuppression
OTC agents Quinine-containing beverages
Alcohol
Malignancy
Nutrient deficiencies folate, vitamin B12, copper an autoimmune mechanism Mild
Thrombotic microangiopathy (TMA) Thrombotic thrombocytopenic purpura (TTP)
Hemolytic uremic syndrome (HUS)
Drug-induced TMA (DITMA)
Bone marrow disorders Myelodysplastic syndromes
Aplastic anemia
Acute leukemia
Paroxysmal nocturnal hemoglobinuria (PNH)
Rheumatologic/autoimmune disorders Systemic lupus erythematosus (SLE)
Antiphospholipid syndrome (APS) autoantibody-mediated syndrome
Felty's syndrome splenomegaly
vascular giant capillary hemangioma, platelet destruction
large aortic aneurysms, platelet destruction
cardiopulmonary bypass platelet destruction
Post-transfusion purpura immune-mediated platelet destruction