PRESENTED:- Dr.

Raju Niraula
 Definitions

 Stages of platelets Developement

 Causes

 Approach to Thrombocytopenic Patient

 Diagnosis

 Treatment
 T hrombocytopenia is defined as an
count less than 150000/mm₃
 Pseudothrombocytopenia –Blood
collected in EDTA tube leads to platelets
clumping due to the presence of antibodies
usually IgG but also IgM IgA
 Decreased
 Production
Hematologic malignancies
 Aplastic anemia
 Myelodysplasia
 Drugs: chemotherapy, alcohol
 Radiation
 HIV
 Hereditary thrombocytopenias
 Metastatic cancer to bone marrow
 Immune
1. ITP
2. HIT
3. Drug-induced antibodies
4. HIV
5. post transfusion purpura
6. Connective tissue diseases
 Nonimmune
7. DIC
8. Sepsis
9. TTP-HUS
10. Kasabach Merrit syndrome
 Sequestrations
1. Hypersplenism
Histot
y usually asymptomatic


 Presence of petechiae, ecchymoses

 Mucocutaneous bleeding
 Purpura
 Rarely central nervous system bleeding
 retinal hemorrhages
History
of…
 Recent Infections
 Malignancies
 Pregnancy status in premenopausal woman
 Recent medications
 Vaccinations
 Recent travels
 Recent transfusions
 Recent organ transplantation
 Family history of thrombocytopenia
 Autoimmune disorders
 presence of petechiae ecchymosis in the skin,
 wet purpura in mucous membranes
 Splenomegaly
 The presence of retinal hemorrhage on ocular
fundus examination is a predictor of CNS
hemorrhage
 Complete blood counts
 Peripheral blood smear
 D-dimer
 Serum LDH
 Bone marrow examinations
 HIV
 ESR
 hsCRP
 Due to the presence of naturally occurring
antibodies that cross-react with the drug bound
to the platelet.
 The thrombocytopenia occurs after a period of
initial exposure of 21 days
 Resolves in 7–10 days after drug withdrawal.
 Abciximab exposure causes
thrombocytopenia within 24 h of initial
exposure.
 Penicillin

Piperacillin
Phenytoin

 Abciximab
 NSAIDs
 Amiodarone
 Amlodipine
 Ampicillin
 Carbamazepine
 Ceftriaxone
 Cephamandole
 Ciprofloxacin
 Diazepam
 Eptifibatide
 Furosemide
 Vancomycin
 The thrombocytopenia is not usually severe,
rarely <20,000/μL.
 Heparin-induced thrombocytopenia (HIT) is
not associated with bleeding, it increases the
risk of thrombosis.
 Antibodies to complex of platelet factor 4
and heparin
 HIT after exposure to heparin for 5–14
days.
HIT (anti-heparin/PF4) antibodies can be
detected using two types of assays.
The most widely available is an enzyme-linked
immunoassay (ELISA).
The other assay is a platelet activation assay,
most commonly the serotonin release
assay,
 Direct thrombin inhibitor (DTI)
- Argatroban
-Fondaparinux
 Xa Inhibitor-Danaparoid
 Warfarin therapy.
 Immune thrombocytopenic purpura (ITP); is an
acquired disorder
 It is immune-mediated destruction of platelets
and inhibition of platelet release from the
megakaryocyte.
 In children, it is usually an acute disease.
 In adults, it is a more chronic disease.
 Secondary ITP if it is associated with an
underlying disorder;
 autoimmune disorders, particularly systemic
lupus erythematosus (SLE),
 infections, such as HIV and hepatitis C.
 ITP is characterized by mucocutaneous
bleeding and a low, often very low platelet
count, with an otherwise normal peripheral
blood cells and smear.
 Patients usually present either with
ecchymoses and petechiae.
 Mucocutaneous bleeding may be present.
Rarely, life-threatening, including
central nervous system bleeding can
occur.
 retinal hemorrhages
 prednisone at 1 mg/kg,
 Anti Rh0(D) immune globulin at 50–75
μg/kg,
Monitoring patients for 8 h after infusion
 Intravenous gamma globulin (IVIgG)
 splenectomy
 Eltrombopag is FDA approved for use in children
over 1 year of age.
 Romiplostim is not yet FDA approved in children
but a randomized trial supports efficacy.
 Immunosuppressive drugs- mycophenolate mofetil
dapsone.
 TTP is related to a deficiency or
antibodies to the metalloprotease
ADAMTS13, which cleaves VWF.
 ADAMTS13 activity levels of <10% are more
clearly associated with antibody-mediated
TTP.
 Idiopathic TTP appears to be more common
in women than in men.
 plasma exchange
 It decreases mortality from 85–100% to 10–
30%.
 HUS is a syndrome characterized
1) Acute renal failure
2) Microangiopathic hemolytic anemia,
3) Thrombocytopenia.

 Escherichia coli O157:H7 is the most frequent

causative agent
 Atypical HUS (aHUS) is usually due to genetic
defects that result in chronic complement
activation or antibodies directed against
complement regulatory proteins.
Indications of platelets
tranfusion
 10,000/uL - prophylactic transfusion
 20,000/uL - in the presence of bleeding,
fever, infection, platelet function defect,
or coagulopathy
 50,000/uL - prior to minor procedures, in
actively anticoagulated patients or in the
presence of active bleeding
 75,000/uL - prior to general surgery
 100,000/uL - prior to neurologic or
ophthalmologic surgery
 Random donor platelet
 Single donor platelet
 Thrombocytopenia if platletes <150000/ul
then Pseudothrombocytopenia should be
ruled out
 Proper history taking and examination for
finding out of different causes
 Peripheral blood smear to find out causes

 Indications of platelets transfusion

<10000/ul
 Harissons 20th
 Wintrobes clinical hematology