The differential diagnosis of thrombocytopenia in critical care
| First rule out pseudothrombocytopenia . |
|---|
| • Clotted blood sample • EDTA-dependent antibodies (collect CBC in anticoagulant such as citrate) • Review medications especially ○ Heparins, including heparin-associated thrombocytopenia ○ IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban) ○ Adenosine diphosphate receptor antagonists (clopidogrel) ○ Acute alcohol toxicity |
| Rule out hematinic deficiency, particularly acute vitamin B12 deficiency which has recently been associated with nitrous oxide abuse . |
| Investigation for the consumption of platelets: . |
| • Sepsis • Major blood loss • Mechanical fragmentation ○ Post–cardiopulmonary bypass ○ Intra-aortic balloon pump ○ Renal dialysis ○ ECMO • Immune mediated ○ Immune thrombocytopenic purpura ○ Antiphospholipid syndrome ○ Posttransfusion purpura • With a microangiopathic hemolytic anemia ○ Disseminated intravascular coagulation ○ Thrombotic thrombocytopenic purpura ○ Hemolytic uremic syndrome • Hypersplenism • Other ○ Myelodysplastic syndrome ○ Malignancy ○ Hereditary thrombocytopenia |
| First rule out pseudothrombocytopenia . |
|---|
| • Clotted blood sample • EDTA-dependent antibodies (collect CBC in anticoagulant such as citrate) • Review medications especially ○ Heparins, including heparin-associated thrombocytopenia ○ IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban) ○ Adenosine diphosphate receptor antagonists (clopidogrel) ○ Acute alcohol toxicity |
| Rule out hematinic deficiency, particularly acute vitamin B12 deficiency which has recently been associated with nitrous oxide abuse . |
| Investigation for the consumption of platelets: . |
| • Sepsis • Major blood loss • Mechanical fragmentation ○ Post–cardiopulmonary bypass ○ Intra-aortic balloon pump ○ Renal dialysis ○ ECMO • Immune mediated ○ Immune thrombocytopenic purpura ○ Antiphospholipid syndrome ○ Posttransfusion purpura • With a microangiopathic hemolytic anemia ○ Disseminated intravascular coagulation ○ Thrombotic thrombocytopenic purpura ○ Hemolytic uremic syndrome • Hypersplenism • Other ○ Myelodysplastic syndrome ○ Malignancy ○ Hereditary thrombocytopenia |
CBC, complete blood count.