Clinical Presentation

* Incidental finding on routing CBC* Petechiae/purpura* Mucosal bleeding* Epistaxis* Gingival bleeding* Hematuria* Vaginal bleeding

5 Major Causes of Thrombocytopenia

* Thrombotic Thrombocytopenic Purpura (TTP)* Clinical presentation (pentad)* Thrombocytopenia* Fever* Microangiopathic hemolytic anemia* “schistocytes”* Neurologic abnormalities* Renal dysfunction* Physiology* Low ADAMTS13 results in impaired vWF breakdown* Widespread “platelet plugs”* Treatment* Plasma exchange* Hemolytic Uremic Syndrome (HUS)* Clinical presentation* Pediatric patient with bloody diarrhea* Renal dysfunction* Thrombocytopenia* Treatment* Supportive care* Heparin Induced Thrombocytopenia (HIT)* Clinical presentation* Recent heparin administration* Acute thrombocytopenia (<150) or 50% decrease in platelets* Treatment* Stop heparin and choose different anticoagulant* Disseminated Intravascular Coagulation (DIC)* Clinical presentation* Patient septic, severe trauma, or otherwise critically ill/injured* Multiple abnormal labs* Increased PT/PTT* Increased D-dimer* Increased fibrinogen degradation products* Treat underlying trigger* Immune/Idiopathic Thrombocytopenic Purpura (ITP)* Common condition* Relatively benign* Treatment* Steroids* Occasionally platelet transfusion* Other causes* HIV* Hepatitis* Heavy alcohol use

Additional Reading

* Thrombocytopenia: An ED Approach (emDOCs)