Thrombocytopenia Causes and Diagnostic Approach

Major Categories of Thrombocytopenia

Bone marrow disorders, including myelodysplastic syndromes, leukemias, and fibrosis, can impair megakaryocyte function, according to the American Society of Hematology 2
Aplastic anemia and megaloblastic anemia affect platelet production, as reported by the American Society of Hematology 2
Inherited thrombocytopenias, such as thrombocytopenia-absent radius syndrome, Wiskott-Aldrich syndrome, and MYH9-related disease, are associated with decreased platelet production, according to the American Society of Hematology 2
Primary immune thrombocytopenia is an autoimmune disorder characterized by immunologic destruction of otherwise normal platelets, as stated by the American College of Rheumatology 1
Secondary immune thrombocytopenia can be associated with autoimmune disorders, infections, lymphoproliferative disorders, and recent vaccinations, according to the American Society of Hematology 2

A complete blood count with differential is recommended to identify isolated thrombocytopenia versus pancytopenia, as suggested by the American Society of Clinical Pathology 1
Peripheral blood smear examination by a qualified hematologist or pathologist is necessary to exclude pseudothrombocytopenia and identify abnormalities inconsistent with ITP, according to the American Society of Hematology 2
Patient history should be taken to identify potential causes, including systemic diseases, infections, medication use, alcohol consumption, environmental toxin exposure, and recent vaccinations or transfusions, as recommended by the American Society of Hematology 2
Testing for HIV and hepatitis C is recommended in adults with suspected immune thrombocytopenia, as stated by the Centers for Disease Control and Prevention 1
Bone marrow examination may be necessary in selected cases, including patients older than 60 years, those with systemic symptoms or abnormal signs, and cases where splenectomy is considered, according to the American Society of Hematology 2
Response to ITP-specific therapy, such as intravenous immunoglobulin, supports but does not confirm the diagnosis of ITP, as reported by the American Society of Hematology 2