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Thrombocytopenia
Related Subjects: |Microangiopathic Haemolytic anaemia |Haemolytic anaemia |Immune(Idiopathic) Thrombocytopenic Purpura (ITP) |Thrombotic Thrombocytopenic purpura (TTP) |Haemolytic Uraemic syndrome (HUS) |Thrombocytopenia |Disseminated Intravascular Coagulation (DIC)
🩸 About
- Thrombocytopenia = reduced platelet count from multiple causes.
- Severe thrombocytopenia: < 20 × 10⁹/L → risk of spontaneous haemorrhage → requires admission.
⚠️ Bleeding Risks
- Spontaneous bleeding: < 10 × 10⁹/L
- Bleeding rare if > 50 × 10⁹/L
- Safe for most trauma/surgery: > 50 × 10⁹/L
- Neurosurgery target: 70–100 × 10⁹/L
🔎 Causes of Thrombocytopenia
- Reduced Production:
- B12 / Folate deficiency
- Uraemia
- Alcohol excess
- Liver disease
- Chemotherapy / Radiotherapy
- Bone marrow disorders: Leukaemia, Lymphoma, Myeloma, Myelofibrosis, Carcinoma
- Decreased Survival / Increased Destruction:
- Immune thrombocytopenic purpura (ITP)
- Systemic lupus erythematosus (SLE)
- Chronic lymphocytic leukaemia (CLL)
- Hodgkin lymphoma
- Drug-related
- Infections: Malaria, viral illnesses
- Consumptive states: DIC, TTP, HUS
- Mechanical: extracorporeal circuits, massive transfusion
- Splenomegaly (sequestration)
💡 Bleeding after dental extraction or long-standing menorrhagia with normal platelets and clotting may suggest inherited platelet function disorders.
🧾 Clinical Assessment
- ITP: Normal Hb and WCC, no organomegaly.
- Acute leukaemia: High WCC, lymphadenopathy, hepatosplenomegaly.
- Aplastic anaemia: Pancytopenia (low Hb + WCC), no organomegaly.
💊 Management
- ❌ Avoid antiplatelet drugs (aspirin, clopidogrel, NSAIDs).
- 💉 Platelet transfusion if bleeding + < 20 × 10⁹/L.
- 🧪 Tranexamic acid 1 g QDS if mild bleeding.
- 📈 Treat underlying cause (deficiency, marrow disease, immune condition, infection).
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