Clinical investigations from the RACP

Investigating the patient with thrombocytopenia

Clinical investigations from the RACP

Investigating the patient with thrombocytopenia

Lindsay Dunlop

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Abstract

There are many causes of thrombocytopenia, ranging from an artefact of the collection medium or clot in the sample to rapidly progressive conditions requiring prompt assessment and therapy, such as thrombotic thrombocytopenic purpura (TTP) or acute leukaemia. The presence or absence of symptoms at presentation, together with the platelet count and a review of the peripheral blood film, may indicate the degree of urgency required in investigating the patient.

Key Points

  • Thrombocytopenia has many causes ranging from artefacts of the collection process to rapidly progressive and potentially fatal disorders.
  • A review of the blood film, for diagnostic purposes and to exclude platelet clumping due to a collection artefact, is a necessary initial investigation.
  • Acquired causes of thrombocytopenia can be classified as due to either decreased platelet production or increased platelet consumption.
  • Unless the cause of thrombocytopenia is hypersplenism secondary to portal hypertension and liver disease, specialist haematologist referral is usually appropriate.