Thrombocytopenia
Decrease in
platelet count than lower limit is thrombocytopenia.
Normal
value in adult: 1,50,000 to 4,50,000 /micro L.
Platelets
plays an important role in blood clotting and wound healing. The risk of
bleeding and thrombosis increases with low platelet count.
Causes:
·
Primary
immune thrombocytopenia: Antibodies are produced against own platelet cells.
·
Drug-induced
immune thrombocytopenia:
-
Heparin-
induced thrombocytopenia
-
Quinine
-
Sulfonamides,
Ampicillin, Vancomycin, Piperacillin
-
Acetaminophen,
Ibuprofen, Naproxen
-
Cimetidine
-
Glycoprotein
llb/llla inhibitors
·
Drug-induced
non-immune thrombocytopenia
-
Valproic-acid
-
Daptomycin
-
Linezoid
·
Infection:
-
Viral
infection
-
Sepsis
-
Helicobacter
pylori
-
Leptospirosis,
Brucellosis, Anaplasmosis
-
Malaria
-
Chronic
liver disease
-
Chronic
alcohol abuse
-
Nutrient
deficiency
-
Autoimmune
disease
-
Pregnancy-induced;
preeclampsia and HELLP syndrome
·
Others:
-
Myelodysplasia
-
Malignancy
-
Paroxysmal
nocturnal hemoglobinuria
-
Thrombotic
thrombocytopenic purpura
-
Hemolytic
uremic syndrome
-
Aplastic
anemia
-
Inherited
Pathophysiology:
Decreased
platelet production:
-
Bone
marrow failure – Aplastic Anemia
-
Bone
marrow suppression due to certain drugs
-
Chronic
alcohol abuse
-
Inherited
-
Viral
infection
-
Nutrient
deficiency, sepsis, myelodysplastic syndrome
Increased
platelet destruction:
-
In
case of immune mediated thrombocytopenia: Anti- platelet auto antibodies binds
to platelet, which causes platelet destruction.
-
In
case of non-immune mediated thrombocytopenia: Mechanical valve replacement patient, pre-eclampsia,
HELLP syndrome, DIC and thrombotic microangiopathy.
Dilutional
thrombocytopenia:
-
Massive
fluid resuscitation and massive blood transfusion.
Signs and symptoms:
If platelet
count is less than 20,000 /micro L, then there are chances of spontaneous
bleeding.
·
History
of bleeding such as, petechia, hemorrhagic bleeding, epistaxis, gingival
bleeding.
·
Physical
examination shows: Petechia, non-palpable purpura, ecchymosis
·
Hepatomegaly
and splenomegaly
·
Enlarged
lymph nodes
Work-up:
·
Complete
blood count
·
Anti-nuclear
antibodies for SLE
·
Anti-phospholipid
antibodies for Antiphospholipid Antibodies Syndrome
·
Liver
function test and coagulation profile
·
Bone-
marrow biopsy
Treatment and management:
In
asymptomatic case: routine monitoring.
In case of bleeding:
platelet transfusion.
·
Primary
immune thrombocytopenia:
-
First
line: Glucocorticoids and IV immune globulins.
-
Second
line: Rituximab, immunosuppressive drugs and splenectomy.
-
Third line: Thrombopoietin receptors agonist.
· Drug-induced: withdrawal of affecting drug component.
References:
1. https://www.ncbi.nlm.nih.gov/books/NBK542208/
2. https://www.webmd.com/a-to-z-guides/thrombocytopenia-causes-treatment
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