Thrombocytopenia differential diagnosis: Difference between revisions

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! rowspan="2" |Disease
! rowspan="2" |Disease
! rowspan="2" |History and symptoms
! rowspan="2" |History and symptoms
! rowspan="2" |Physical exam
! colspan="3" |Laboratory findings
! colspan="3" |Laboratory findings
! rowspan="2" |Pathology
! rowspan="2" |Pathology
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* [[Weight loss]]
* [[Weight loss]]
* [[Embolism|Embolic symptoms]]
* [[Embolism|Embolic symptoms]]
|
====== Skin ======
* [[Petechiae]]
* [[Splinter hemorrhages]]
* [[Osler's nodes]]
* [[Janeway lesion|Janeway lesions]]
====== Oral Cavity ======
* [[Periodontal diseases|Periodontal]] abnormalities
====== Eyes ======
* [[Conjunctival hemorrhage]]
* [[Roth's spot|Roth's spots]] in the [[retina]]
====== Ear Nose and Throat ======
* Bobbing of the [[uvula]] may be present among patients with new onset [[aortic regurgitation]].
====== Cardiovascular ======
* Heart [[Murmur|murmurs]]
* Wide [[pulse pressure]]
====== Lungs ======
* [[Rales]] as a result of [[heart failure]]
====== Abdomen ======
* [[Abdominal pain]] and [[reduced bowel sounds]] due to mesenteric embolization or [[ileus]]
* [[Splenomegaly]]
* [[Flank pain]] as a result of an [[embolus to the kidney]].
====== Neurologic ======
* [[Septic emboli]] may result in [[stroke]] and focal neurologic findings
* [[Seizures]]
* [[Intracranial hemorrhage]]
|<nowiki>+/↑</nowiki>
|<nowiki>+/↑</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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* [[Cyanosis]]
* [[Cyanosis]]
* [[Fever]]  
* [[Fever]]  
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| rowspan="2" |'''Chemical/poisoning'''
| rowspan="2" |'''Chemical/poisoning'''
|[[Strontium-89]]
|[[Strontium-89]]
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|-
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|[[zinc]]
|[[zinc]]
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| rowspan="4" |'''Dermatologic'''
| rowspan="4" |'''Dermatologic'''
|[[Cholesterol embolism]]
|[[Cholesterol embolism]]
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|-
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|[[Elejalde syndrome]]
|[[Elejalde syndrome]]
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|-
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|[[Griscelli syndrome|Griscelli syndrome type 1]]
|[[Griscelli syndrome|Griscelli syndrome type 1]]
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|-
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|[[neuroectodermal melanolysosomal disease]]
|[[neuroectodermal melanolysosomal disease]]
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| rowspan="4" |'''Ear Nose Throat'''
| rowspan="4" |'''Ear Nose Throat'''
|[[Alport syndrome]]
|[[Alport syndrome]]
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|-
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|Arias oculootoradial syndrome
|Arias oculootoradial syndrome
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|-
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|[[Epstein's syndrome]]
|[[Epstein's syndrome]]
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|-
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|[[Fechtner syndrome]]
|[[Fechtner syndrome]]
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|'''Endocrine'''
|'''Endocrine'''
|[[Immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
|[[Immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
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| rowspan="4" |'''Gastroenterologic'''
| rowspan="4" |'''Gastroenterologic'''
|[[Aminoaciduria|Dibasic aminoaciduria type 2]]
|[[Aminoaciduria|Dibasic aminoaciduria type 2]]
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|-
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|[[liver failure]]
|[[liver failure]]
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|-
|-
|[[Niemann-Pick disease|Niemann-Pick disease type b]]
|[[Niemann-Pick disease|Niemann-Pick disease type b]]
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|-
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|[[portal hypertension]]
|[[portal hypertension]]
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| rowspan="14" |'''Genetic'''
| rowspan="14" |'''Genetic'''
|[[Aicardi-Goutieres syndrome]]
|[[Aicardi-Goutieres syndrome]]
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|-
|-
|[[Chediak-Higashi disease]]
|[[Chediak-Higashi disease]]
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|-
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|[[Factor H|complement factor H deficiency]]
|[[Factor H|complement factor H deficiency]]
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|-
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|[[Elejalde syndrome]]
|[[Elejalde syndrome]]
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|-
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|[[Fanconi anaemia]]
|[[Fanconi anaemia]]
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|-
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|[[Fechtner syndrome]]
|[[Fechtner syndrome]]
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|-
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|[[Griscelli syndrome|Griscelli syndrome type 1]]
|[[Griscelli syndrome|Griscelli syndrome type 1]]
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|-
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|[[holocarboxylase synthase deficiency]]
|[[holocarboxylase synthase deficiency]]
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|-
|-
|[[iminodipeptiduria]]
|[[iminodipeptiduria]]
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|-
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|[[Jacobsen syndrome]]
|[[Jacobsen syndrome]]
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|-
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|[[MELAS]]
|[[MELAS]]
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|-
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|[[Omenn syndrome]]
|[[Omenn syndrome]]
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|-
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|[[TAR syndrome]]
|[[TAR syndrome]]
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|-
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|[[X-linked hyperimmunoglobulin M syndrome]]
|[[X-linked hyperimmunoglobulin M syndrome]]
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| rowspan="33" |'''Hematologic'''
| rowspan="33" |'''Hematologic'''
|[[Acquired pure megakaryocytic aplasia]]
|[[Acquired pure megakaryocytic aplasia]]
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|-
|-
|[[aplastic anemia]]
|[[aplastic anemia]]
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|<nowiki>+ / ↓</nowiki>
|<nowiki>+ / ↓</nowiki>
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|-
|-
|[[Bernard-Soulier syndrome]]
|[[Bernard-Soulier syndrome]]
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|-
|-
|[[Thrombocytopenia|congenital amegakaryocytic thrombocytopenia (CAMT)]]
|[[Thrombocytopenia|congenital amegakaryocytic thrombocytopenia (CAMT)]]
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|-
|-
|[[disseminated intravascular coagulation]]
|[[disseminated intravascular coagulation]]
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|-
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|[[Epstein's syndrome]]
|[[Epstein's syndrome]]
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|-
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|[[familial histiocytic reticulosis]]
|[[familial histiocytic reticulosis]]
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|-
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|[[Gasser syndrome]]
|[[Gasser syndrome]]
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|-
|-
|[[GATA1|GATA1-related cytopenia]]
|[[GATA1|GATA1-related cytopenia]]
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|-
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|[[Glanzmann's thrombasthenia]]
|[[Glanzmann's thrombasthenia]]
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|-
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|[[grey platelet syndrome]]
|[[grey platelet syndrome]]
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|-
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|[[hemolytic uremic syndrome]]
|[[hemolytic uremic syndrome]]
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|-
|-
|[[histiocytosis X]]
|[[histiocytosis X]]
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|-
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|[[hypersplenism]]
|[[hypersplenism]]
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|-
|-
|[[idiopathic thrombocytopenic purpura]]
|[[idiopathic thrombocytopenic purpura]]
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|-
|-
|[[Jacobsen syndrome]]
|[[Jacobsen syndrome]]
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|-
|-
|[[Kasabach-Merritt syndrome]]
|[[Kasabach-Merritt syndrome]]
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|-
|-
|[[May-Hegglin anomaly]]
|[[May-Hegglin anomaly]]
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|-
|[[Moschcowitz syndrome]]
|[[Moschcowitz syndrome]]
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|-
|-
|[[myelodysplastic syndrome]]
|[[myelodysplastic syndrome]]
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|-
|-
|[[myelofibrosis]]
|[[myelofibrosis]]
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|-
|-
|[[neonatal alloimmune thrombocytopenia]]
|[[neonatal alloimmune thrombocytopenia]]
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|-
|-
|[[pancytopenia]]
|[[pancytopenia]]
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|-
|-
|Paris-Trousseau thrombocytopenia
|Paris-Trousseau thrombocytopenia
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|-
|-
|[[paroxysmal nocturnal hemoglobinuria]]
|[[paroxysmal nocturnal hemoglobinuria]]
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|-
|-
|[[post-transfusion purpura]]
|[[post-transfusion purpura]]
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|-
|-
|[[TAR syndrome|radial aplasia-thrombocytopenia syndrome]]
|[[TAR syndrome|radial aplasia-thrombocytopenia syndrome]]
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|-
|-
|[[Sebastian platelet syndrome]]
|[[Sebastian platelet syndrome]]
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|-
|-
|[[Shwachman-Diamond syndrome]]
|[[Shwachman-Diamond syndrome]]
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|-
|-
|[[thrombotic thrombocytopenic purpura]]
|[[thrombotic thrombocytopenic purpura]]
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|-
|-
|[[Von Willebrand disease|Von Willebrand disease, platelet type]]
|[[Von Willebrand disease|Von Willebrand disease, platelet type]]
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|-
|-
|[[Werlhof disease]]
|[[Werlhof disease]]
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|-
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|[[Wiskott-Aldrich syndrome]]
|[[Wiskott-Aldrich syndrome]]
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| rowspan="5" |'''Iatrogenic'''
| rowspan="5" |'''Iatrogenic'''
|[[Coronary artery bypass surgery|Cardiac bypass]]
|[[Coronary artery bypass surgery|Cardiac bypass]]
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|-
|-
|[[chemotherapy]]
|[[chemotherapy]]
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|-
|-
|[[Intra-aortic balloon pump|intra-aortic balloon pump placement]]
|[[Intra-aortic balloon pump|intra-aortic balloon pump placement]]
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|-
|[[Blood transfusion|massive blood transfusion]]
|[[Blood transfusion|massive blood transfusion]]
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|-
|-
|[[radiation therapy]]
|[[radiation therapy]]
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| rowspan="25" |'''Infectious diseases'''
| rowspan="25" |'''Infectious diseases'''
|[[Congenital syphilis]]
|[[Congenital syphilis]]
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|-
|-
|[[cytomegalovirus]]
|[[cytomegalovirus]]
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|-
|-
|[[Dengue fever]]
|[[Dengue fever]]
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|-
|-
|[[ehrlichiosis]]
|[[ehrlichiosis]]
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|-
|-
|[[Epstein-Barr virus]]
|[[Epstein-Barr virus]]
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|-
|-
|[[hantavirus]]
|[[hantavirus]]
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|-
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|[[hepatitis C]]
|[[hepatitis C]]
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|-
|-
|[[HIV]]
|[[HIV]]
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|-
|-
|[[human granulocytic ehrlichiosis]]
|[[human granulocytic ehrlichiosis]]
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|-
|-
|[[Ehrlichiosis|human monocytotropic ehrlichiosis]]
|[[Ehrlichiosis|human monocytotropic ehrlichiosis]]
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|-
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|[[lassa fever]]
|[[lassa fever]]
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|[[leptospirosis]]
|[[leptospirosis]]
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|-
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|[[malaria]]
|[[malaria]]
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|[[measles]]
|[[measles]]
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|-
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|[[mumps]]
|[[mumps]]
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|-
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|[[mycoplasma pneumonia]]
|[[mycoplasma pneumonia]]
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|-
|-
|[[Relapsing fever|Oklahoma tick fever]]
|[[Relapsing fever|Oklahoma tick fever]]
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|-
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|[[parvovirus]]
|[[parvovirus]]
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|-
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|[[Q fever]]
|[[Q fever]]
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|-
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|[[rubella]]
|[[rubella]]
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|-
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|sepsis
|sepsis
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|[[tick-borne encephalitis]]
|[[tick-borne encephalitis]]
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|-
|-
|[[Toxic shock syndrome|toxic shock syndrome (staphylococcal)]]
|[[Toxic shock syndrome|toxic shock syndrome (staphylococcal)]]
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|-
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|[[varicella]]
|[[varicella]]
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|-
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|[[visceral leishmaniasis]]
|[[visceral leishmaniasis]]
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| rowspan="14" |'''Nutritional/Metabolic'''
| rowspan="14" |'''Nutritional/Metabolic'''
|[[folate deficiency]]
|[[folate deficiency]]
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|-
|-
|[[Gaucher disease]]
|[[Gaucher disease]]
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|-
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|[[holocarboxylase synthase deficiency]]
|[[holocarboxylase synthase deficiency]]
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|-
|-
|[[iminodipeptiduria]]
|[[iminodipeptiduria]]
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|-
|-
|[[iron deficiency]]
|[[iron deficiency]]
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|-
|-
|[[isovaleric acidaemia]]
|[[isovaleric acidaemia]]
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|-
|-
|[[Methylmalonic aciduria|methylmalonic aciduria type 2]]
|[[Methylmalonic aciduria|methylmalonic aciduria type 2]]
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|-
|-
|[[CD36|platelet glycoprotein 4 deficiency]]
|[[CD36|platelet glycoprotein 4 deficiency]]
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|-
|-
|[[platelet glycoprotein Ib deficiency]]
|[[platelet glycoprotein Ib deficiency]]
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|-
|-
|[[prolidase deficiency]]
|[[prolidase deficiency]]
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|-
|-
|[[propionyl-CoA carboxylase deficiency]]
|[[propionyl-CoA carboxylase deficiency]]
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|-
|-
|[[sea blue histiocytosis]]
|[[sea blue histiocytosis]]
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|-
|-
|[[sitosterolemia]]
|[[sitosterolemia]]
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|-
|-
|[[vitamin B12 deficiency]]
|[[vitamin B12 deficiency]]
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| rowspan="2" |'''Obstetric/Gynecologic'''
| rowspan="2" |'''Obstetric/Gynecologic'''
|[[Eclampsia]], [[pre-eclampsia]]
|[[Eclampsia]], [[pre-eclampsia]]
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|-
|-
|[[HELLP syndrome]]
|[[HELLP syndrome]]
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| rowspan="11" |'''Oncologic'''
| rowspan="11" |'''Oncologic'''
|[[Acute lymphoblastic leukemia]]
|[[Acute lymphoblastic leukemia]]
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|-
|-
|[[acute myeloid leukemia]]
|[[acute myeloid leukemia]]
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|-
|-
|[[acute promyelocytic leukemia]]
|[[acute promyelocytic leukemia]]
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|-
|-
|[[chronic lymphocytic leukaemia]]
|[[chronic lymphocytic leukaemia]]
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|-
|-
|[[chronic myeloid leukaemia]]
|[[chronic myeloid leukaemia]]
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|-
|-
|[[hairy cell leukaemia]]
|[[hairy cell leukaemia]]
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|-
|-
|[[hepatosplenic T-cell lymphoma]]
|[[hepatosplenic T-cell lymphoma]]
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|-
|-
|[[lymphoma]]
|[[lymphoma]]
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|-
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|[[myeloma]]
|[[myeloma]]
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Line 1,004: Line 1,156:
|-
|-
|[[Non-Hodgkins lymphoma]]
|[[Non-Hodgkins lymphoma]]
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|-
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|[[paraneoplastic syndrome]]
|[[paraneoplastic syndrome]]
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| rowspan="2" |'''Overdose/Toxicity'''
| rowspan="2" |'''Overdose/Toxicity'''
|[[ethanol]]
|[[ethanol]]
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Line 1,029: Line 1,184:
|-
|-
|[[arsenic trioxide]]
|[[arsenic trioxide]]
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|'''Pulmonary'''
|'''Pulmonary'''
|[[Acute respiratory distress syndrome]]
|[[Acute respiratory distress syndrome]]
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|'''Renal/Electrolyte'''
|'''Renal/Electrolyte'''
|[[hemolytic uremic syndrome]]
|[[hemolytic uremic syndrome]]
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| rowspan="10" |'''Rheumatology/Immunology/Allergy'''
| rowspan="10" |'''Rheumatology/Immunology/Allergy'''
|[[Anticardiolipin syndrome]]
|[[Anticardiolipin syndrome]]
|
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Line 1,064: Line 1,223:
|-
|-
|[[antiphospholipid syndrome]]
|[[antiphospholipid syndrome]]
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Line 1,072: Line 1,232:
|-
|-
|[[autoimmune lymphoproliferative syndrome type 1]]
|[[autoimmune lymphoproliferative syndrome type 1]]
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Line 1,080: Line 1,241:
|-
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|[[autoimmune lymphoproliferative syndrome type 2]]
|[[autoimmune lymphoproliferative syndrome type 2]]
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Line 1,088: Line 1,250:
|-
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|[[Factor H|complement factor H deficiency]]
|[[Factor H|complement factor H deficiency]]
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Line 1,096: Line 1,259:
|-
|-
|[[Evans syndrome]]
|[[Evans syndrome]]
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Line 1,104: Line 1,268:
|-
|-
|[[immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
|[[immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
|
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Line 1,112: Line 1,277:
|-
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|[[macrophage-activation syndrome]]
|[[macrophage-activation syndrome]]
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Line 1,120: Line 1,286:
|-
|-
|[[neonatal alloimmune thrombocytopenia]]
|[[neonatal alloimmune thrombocytopenia]]
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Line 1,128: Line 1,295:
|-
|-
|[[systemic lupus erythematosus]]
|[[systemic lupus erythematosus]]
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Line 1,137: Line 1,305:
|'''Miscellaneous'''
|'''Miscellaneous'''
|[[Snakebites]]
|[[Snakebites]]
|
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Revision as of 10:45, 8 August 2018

Thrombocytopenia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Thrombocytopenia from other Diseases

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

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

Overview

Thrombocytopenia has a broad range of potential causes. While a good history and physical examination can be helpful to diagnose some of these causes such as drug-induced thrombocytopenia, they usually don't suffice and further evaluation is often needed. There are also some useful points that may guide the physician to an appropriate diagnosis. For example, asymptomatic, isolated thrombocytopenia most probably suggests ITP, while thrombocytopenia in critically ill, hospitalized patients is usually suggestive of iatrogenic causes (eg. dilution), platelet consumption, bone marrow suppression from infection/sepsis, or even drug-induced thrombocytopenia. One should consider however, that a wide variety of other conditions such as autoimmune disorders, nutrient deficiencies, thrombotic microangiopathies could all as well cause thrombocytopenia.

Differential Diagnosis

Category Disease History and symptoms Physical exam Laboratory findings Pathology Other specifics
WBC changes RBC changes other findings
Cardiovascular endocarditis[1]
Skin
Oral Cavity
Eyes
Ear Nose and Throat
Cardiovascular
Lungs
Abdomen
Neurologic
 +/↑ -
pulmonary embolism[2]
Chemical/poisoning Strontium-89
zinc
Dermatologic Cholesterol embolism
Elejalde syndrome
Griscelli syndrome type 1
neuroectodermal melanolysosomal disease
Ear Nose Throat Alport syndrome
Arias oculootoradial syndrome
Epstein's syndrome
Fechtner syndrome
Endocrine Immunodysregulation polyendocrinopathy and enteropathy, X-linked
Gastroenterologic Dibasic aminoaciduria type 2
liver failure
Niemann-Pick disease type b
portal hypertension
Genetic Aicardi-Goutieres syndrome
Chediak-Higashi disease
complement factor H deficiency
Elejalde syndrome
Fanconi anaemia
Fechtner syndrome
Griscelli syndrome type 1
holocarboxylase synthase deficiency
iminodipeptiduria
Jacobsen syndrome
MELAS
Omenn syndrome
TAR syndrome
X-linked hyperimmunoglobulin M syndrome
Hematologic Acquired pure megakaryocytic aplasia
aplastic anemia + / ↓ + / ↓
Bernard-Soulier syndrome
congenital amegakaryocytic thrombocytopenia (CAMT)
disseminated intravascular coagulation
Epstein's syndrome
familial histiocytic reticulosis
Gasser syndrome
GATA1-related cytopenia
Glanzmann's thrombasthenia
grey platelet syndrome
hemolytic uremic syndrome
histiocytosis X
hypersplenism
idiopathic thrombocytopenic purpura
Jacobsen syndrome
Kasabach-Merritt syndrome
May-Hegglin anomaly
Moschcowitz syndrome
myelodysplastic syndrome
myelofibrosis
neonatal alloimmune thrombocytopenia
pancytopenia
Paris-Trousseau thrombocytopenia
paroxysmal nocturnal hemoglobinuria
post-transfusion purpura
radial aplasia-thrombocytopenia syndrome
Sebastian platelet syndrome
Shwachman-Diamond syndrome
thrombotic thrombocytopenic purpura
Von Willebrand disease, platelet type
Werlhof disease
Wiskott-Aldrich syndrome
Iatrogenic Cardiac bypass
chemotherapy
intra-aortic balloon pump placement
massive blood transfusion
radiation therapy
Infectious diseases Congenital syphilis
cytomegalovirus
Dengue fever
ehrlichiosis
Epstein-Barr virus
hantavirus
hepatitis C
HIV
human granulocytic ehrlichiosis
human monocytotropic ehrlichiosis
lassa fever
leptospirosis
malaria
measles
mumps
mycoplasma pneumonia
Oklahoma tick fever
parvovirus
Q fever
rubella
sepsis
tick-borne encephalitis
toxic shock syndrome (staphylococcal)
varicella
visceral leishmaniasis
Nutritional/Metabolic folate deficiency
Gaucher disease
holocarboxylase synthase deficiency
iminodipeptiduria
iron deficiency
isovaleric acidaemia
methylmalonic aciduria type 2
platelet glycoprotein 4 deficiency
platelet glycoprotein Ib deficiency
prolidase deficiency
propionyl-CoA carboxylase deficiency
sea blue histiocytosis
sitosterolemia
vitamin B12 deficiency
Obstetric/Gynecologic Eclampsia, pre-eclampsia
HELLP syndrome
Oncologic Acute lymphoblastic leukemia
acute myeloid leukemia
acute promyelocytic leukemia
chronic lymphocytic leukaemia
chronic myeloid leukaemia
hairy cell leukaemia
hepatosplenic T-cell lymphoma
lymphoma
myeloma
Non-Hodgkins lymphoma
paraneoplastic syndrome
Overdose/Toxicity ethanol
arsenic trioxide
Pulmonary Acute respiratory distress syndrome
Renal/Electrolyte hemolytic uremic syndrome
Rheumatology/Immunology/Allergy Anticardiolipin syndrome
antiphospholipid syndrome
autoimmune lymphoproliferative syndrome type 1
autoimmune lymphoproliferative syndrome type 2
complement factor H deficiency
Evans syndrome
immunodysregulation polyendocrinopathy and enteropathy, X-linked
macrophage-activation syndrome
neonatal alloimmune thrombocytopenia
systemic lupus erythematosus
Miscellaneous Snakebites

References

  1. ↑ Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis Accessed on September 24, 2015
  2. ↑ Cohen AT, Dobromirski M, Gurwith MM (2014). "Managing pulmonary embolism from presentation to extended treatment". Thromb Res. 133 (2): 139–48. doi:10.1016/j.thromres.2013.09.040. PMID 24182642.

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