Thrombocytopenia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor-In-Chief: Farbod Zahedi Tajrishi, M.D. [2]


On physical examination of patients with thrombocytopenia, the physician should search for signs of bleeding on skin and in other organ systems, hepatosplenomegaly, lymphadenopathy, and signs of thrombosis, all of which could be a guide for the diagnosis of the underlying cause.

Physical Examination

A set of signs can be present in thrombocytopenia, each of which suggesting different potential underlying causes. These include:[1]

  • signs of bleeding
  • hepatosplenomegaly
  • lymphadenopathy
  • signs of thrombosis
physical finding categories further explanations
bleeding - Bleeding into the skin in the form of petechiae, purpura or overt mucusal bleeding is common in thrombocytopenia. Thrombocytopenic Bleeding due to thrombocytopenia is different from the bleeding seen in coagulopathies.

- Wet purpura often suggests a higher probability of serious bleedings. Palpable purpura is not common in thrombocytopenia and is mostly seen in vascular or inflammatory diseases.

- Bleeding may also happen in every other organ systems, including the gastrointestinal tract (eg. occult blood in the stool) or genitourinary tract (eg. hematuria). In these settings, appropriate evaluation of bleeding is warranted even if the etiology of thrombocytopenia is clear.

hepatosplenomegaly Hepatosplenomegaly may suggest one of these conditions: Splenomegaly due to any etiology could result in mild thrombocytopenia.
  • focal
  • generalized
- Lymphadenopathy and coexisting thrombocytopenia could be a sign of:

- Focal, tender lymphadenopathy most commonly suggests localized bacterial infection.

- Generalized lymphadenopathy could be a sign of acute HIV infection.

thromboses - - Though not common, patients with thrombocytopenia are at risk of thrombosis rather than bleeding in certain conditions. Examples of these life-threatening conditions include:


  1. Greenberg EM, Kaled ES (2013). "Thrombocytopenia". Crit Care Nurs Clin North Am. 25 (4): 427–34, v. doi:10.1016/j.ccell.2013.08.003. PMID 24267279.

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