Materiały źródłowe

• #1 Platelet Disorders – Thrombocytopenia | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/thrombocytopenia

  Thrombocytopenia is a condition that occurs when the platelet count in your blood is too low. […] A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood. […] To diagnose thrombocytopenia, your provider will ask about your medical and family history. They will also ask about your symptoms and do a physical exam to look for signs of bleeding. […] Your provider may order one or more of the following blood tests: Complete blood count (CBC): This test measures the levels of platelets and other blood cells in your blood. […] Blood smear: For this test, some of your blood is put on a slide. A microscope is used to look at your platelets. […] Bone marrow tests: These tests check whether your bone marrow is healthy. […] Treatment for thrombocytopenia depends on what caused it and whether you have any symptoms.

• #2 Thrombocytopenia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK542208/

  Thrombocytopenia is a platelet count below the lower limit of normal, i.e., 150000/microliter (for adults). This activity reviews the etiology, evaluation, and management of thrombocytopenia and highlights the role of the interprofessional team in improving care for patients with this condition. […] Explain the appropriate history, physical, associated laboratory values, and evaluation of thrombocytopenia. […] Evaluation of patients with isolated thrombocytopenia includes obtaining a CBC, peripheral blood smear, HIV, and HCV tests. […] Bone marrow biopsy is indicated in conditions when the cause of thrombocytopenia is unclear, and when a hematologic disorder is suspected. […] Newly-diagnosed patients with thrombocytopenia are referred to a hematologist to confirm the diagnosis. In patients with unexplained thrombocytopenia, consulting hematologist is the recommendation. Immediate consultation is necessary for conditions like TTP, HUS, HIT, aplastic anemia, leukemia, and other bone marrow failure conditions.

• #3 Thrombocytopenia (low platelet count) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thrombocytopenia/diagnosis-treatment/drc-20378298

  The following can be used to determine whether you have thrombocytopenia: […] A complete blood count determines the number of blood cells, including platelets, in a sample of your blood. […] Your doctor might suggest other tests and procedures to determine the cause of your condition, depending on your signs and symptoms. […] For thrombocytopenia, questions to ask your doctor include: How many platelets do I have in my blood? […] Is my platelet count dangerously low? […] What is causing my thrombocytopenia? […] Do I need more tests? […] Is my condition likely temporary or chronic? […] What are my treatment options? […] What will happen if I do nothing? […] Are there any restrictions that I need to follow? […] Are there printed materials I can have? What websites do you recommend?

• #4 Thrombocytopenia: Symptoms, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/14430-thrombocytopenia

  Healthcare providers will do a physical examination. Theyll check for bruises, rashes and other thrombocytopenia symptoms. Theyll ask about your medical history, including any medications you take. They may do tests including: […] Providers will check your platelet levels and your white and red blood cell levels. […] If blood tests show a low platelet count, your healthcare provider may do a bone marrow biopsy. […] You might not need treatment if a low platelet count isnt causing significant issues. Often, healthcare providers can improve platelet counts by treating the underlying cause. This approach may involve changing your medications. Other treatments include: […] If you have thrombocytopenia, ask your healthcare provider what caused the issue and what treatment or lifestyle changes they recommend. […] Your healthcare provider can explain whats causing the low platelet count and discuss treatment options. Theyll also discuss lifestyle changes that may boost your platelet levels.

• #5 Thrombocytopenia and Platelet Function Disorders | Doctor

  https://patient.info/doctor/thrombocytopenia-and-platelet-function-disorders

  Diagnosing thrombocytopenia (investigations)9 […] A thorough history and examination are essential, with consideration of any history or indication of a possible underlying cause, and any history of abnormal bleeding. […] When a low platelet count is picked up incidentally, the FBC must be repeated and a blood smear performed.3 […] Initial laboratory test should include FBC with differential and a blood film, prothrombin time, activated partial thromboplastin time (aPTT), renal function and TFTs. […] HIV and HCV tests should be carried out as thrombocytopenia may be the only sign of infection for several years.13 […] Bone marrow examination may be required for patients over 60 years of age, unless immune thrombocytopenia can be confidently diagnosed, (mainly to exclude dysplasia) and in those with systemic symptoms or signs suggestive of haematological cancer.3

• #6 Thrombocytopenia – symptoms, causes, diagnosis and treatment | healthdirect

  https://www.healthdirect.gov.au/thrombocytopenia

  Thrombocytopenia is when you have low levels of platelets in your blood. […] Treatment depends on the cause of your thrombocytopenia. […] If you are worried that you or your child has thrombocytopenia, visit your doctor. […] Your doctor will ask about your symptoms and general health. They will want to know how long you have had symptoms and what medicines you are taking. […] They will examine you and order blood tests. If you have thrombocytopenia, blood tests will show a low platelet count. […] You may have other tests to investigate the cause of your thrombocytopenia. […] Your doctor may refer you to a specialist, such as a haematologist (blood doctor).

• #7 Thrombocytopenia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0315/p612.html

  Pseudothrombocytopenia is secondary to platelet clumping and has no clinical significance. It occurs in one in 1,000 persons in the general population, and can be confirmed by a peripheral blood smear. The platelet count should be repeated by collecting blood in a tube with a non-ethylenediaminetetraacetic acid anticoagulant, such as heparin or sodium citrate. If the complete blood count still shows thrombocytopenia, other causes should be investigated. […] Immune thrombocytopenic purpura is an acquired immune-mediated disorder characterized by isolated thrombocytopenia and the absence of other conditions or agents known to induce thrombocytopenia. The incidence is 100 cases per 1 million persons annually, and approximately 50 percent of cases occur in children. Immune thrombocytopenic purpura in children often resolves spontaneously but tends to be more insidious and chronic in adults. The risk of bleeding correlates to the severity of thrombocytopenia.

• #8 Immune Thrombocytopenia (ITP) Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/202158-workup

  The workup for immune thrombocytopenia (ITP) starts with a complete blood cell (CBC) count. The hallmark of ITP is isolated thrombocytopenia; anemia and/or neutropenia may indicate other diseases. […] The diagnosis of this type of pseudothrombocytopenia is established if the platelet count is normal when repeated on a sample from heparin-anticoagulated or citrate-anticoagulated blood. […] The value of bone marrow evaluation for a diagnosis of ITP is unresolved, and more data are needed to establish clear guidelines. […] American Society of Hematology guidelines advise that bone marrow examination is not necessary in children and adolescents with the typical features of ITP, or in children in whom intravenous immunoglobulin therapy fails. […] Bone marrow examination is indicated in children with atypical hematologic findings, such as immature cells on the peripheral smear or persistent neutropenia.

• #9 Thrombocytopenia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/thrombocytopenia.html

  Thrombocytopenia is a platelet count of less than 150 103 per L and can occur from decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping. […] In stable patients being evaluated as outpatients, the first step is to exclude pseudothrombocytopenia by collecting blood in a tube containing heparin or sodium citrate and repeating the platelet count. If thrombocytopenia is confirmed, the next step is to distinguish acute from chronic thrombocytopenia by obtaining or reviewing previous platelet counts. […] Common nonemergency causes of thrombocytopenia include drug-induced thrombocytopenia, immune thrombocytopenia, and hepatic disease. […] A peripheral blood smear is recommended for all patients with thrombocytopenia to evaluate the presence of fragmented red blood cells (schistocytes), which suggests microangiopathic hemolytic anemia (associated with thrombocytopenia).

• #10 Thrombocytopenia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/thrombocytopenia.html

  In patients who are asymptomatic, a reasonable approach includes a disseminated intravascular coagulation panel (e.g., fibrinogen, d-dimer, coagulation factors); hemolysis screen (i.e., direct antiglobulin [Coombs] test, haptoglobin, and lactate dehydrogenase); renal and hepatic function tests; selected viral serologies (e.g., hepatitis, HIV); Helicobacter pylori stool antigen testing, fecal occult blood test, vitamin B12, and folate levels. […] Patients often require hospitalization, but newly diagnosed ITP with platelet counts of 20 103 per L or greater in patients who are asymptomatic or with minimal mucosal bleeding can be managed in the outpatient setting, provided that definitive hematology follow-up is performed within 24 to 72 hours. […] Initial therapy is corticosteroids or intravenous immune globulin (human) infusion. Recurrent or unresponsive cases are treated with thrombopoietin receptor agonists or immunomodulators (e.g., rituximab).

• #11 Thrombocytopenic Disorders | Choose the Right Test

  https://arupconsult.com/content/thrombocytopenic-disorders

  Thrombocytopenia is a common clinical condition with a broad differential diagnosis, and identifying its etiology involves careful assessment of both clinical characteristics and the results of well-chosen laboratory tests. […] Initial and essential laboratory tests in all cases include a CBC and a peripheral blood smear, which can provide important clues about the etiology of the thrombocytopenia. […] Diagnosis is generally based on clinical features, CBC, and evaluation of the peripheral blood smear to rule out other hematologic conditions. […] Testing for thrombocytopenic disorders should be considered in patients with platelet counts 100-150 x 109/L. […] The first step in a workup for a suspected thrombocytopenic disorder is to confirm the thrombocytopenia by repeating the CBC and/or performing peripheral smear review.

• #12 Thrombocytopenic Disorders | Choose the Right Test

  https://arupconsult.com/content/thrombocytopenic-disorders

  Once thrombocytopenia is confirmed, results should be considered in light of the clinical context (eg, newborn, pregnant, or asymptomatic patient; bleeding or thrombosis; other cytopenias; current medical conditions and medications), which provides essential clues as to the etiology. […] Secondary testing should be performed based on the patients history and clinical presentation to identify the cause of the thrombocytopenia. […] Thrombocytopenic disorders are generally associated with either decreased platelet production or increased platelet destruction (either immune mediated or nonimmune mediated). […] Diagnosis generally based on clinical features, CBC, and blood smear; immune thrombocytopenia is a diagnosis of exclusion.

• #13 Immune thrombocytopenia (ITP) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/idiopathic-thrombocytopenic-purpura/diagnosis-treatment/drc-20352330

  To diagnose immune thrombocytopenia, a health care provider will try to rule out other possible causes of bleeding and a low platelet count. […] No one test can prove the diagnosis. Blood tests can check platelet levels. Rarely, adults might need a bone marrow biopsy to rule out other problems. […] Diagnosing immune thrombocytopenia usually involves more blood tests. Your provider might send you to a specialist in blood diseases, also known as a hematologist.

• #14 Thrombocytopenia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK542208/

  Thrombocytopenia is a platelet count below the lower limit of normal, i.e., 150000/microliter (for adults). This activity reviews the etiology, evaluation, and management of thrombocytopenia and highlights the role of the interprofessional team in improving care for patients with this condition. […] Explain the appropriate history, physical, associated laboratory values, and evaluation of thrombocytopenia. […] Evaluation of patients with isolated thrombocytopenia includes obtaining a CBC, peripheral blood smear, HIV, and HCV tests. […] Bone marrow biopsy is indicated in conditions when the cause of thrombocytopenia is unclear, and when a hematologic disorder is suspected. […] Newly-diagnosed patients with thrombocytopenia are referred to a hematologist to confirm the diagnosis. In patients with unexplained thrombocytopenia, consulting hematologist is the recommendation. Immediate consultation is necessary for conditions like TTP, HUS, HIT, aplastic anemia, leukemia, and other bone marrow failure conditions.

• #15 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  The value of bone marrow evaluation for a diagnosis of ITP is unresolved. […] Biopsy in patients with ITP shows a normal-to-increased number of megakaryocytes in the absence of other significant abnormalities. […] In adults older than 60 years, biopsy is used to exclude myelodysplastic syndrome or leukemia. […] Unresponsiveness to standard treatment after 6 months is an indication for bone marrow aspiration.

• #16 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Immune thrombocytopenia is suspected in patients with isolated thrombocytopenia (ie, otherwise normal CBC and peripheral blood smear). […] Diagnosis is usually clinical, based on exclusion of other causes of thrombocytopenia (eg, HIV infection, hepatitis C infection). […] Complete blood count (CBC) with platelets and peripheral blood smear. […] Exclusion of other thrombocytopenic disorders. […] Testing for antiplatelet antibodies may aid the diagnosis in some cases. […] Bone marrow examination is not required to make the diagnosis but is done if blood counts or blood smear reveals abnormalities in addition to thrombocytopenia, when clinical features are not typical, or if patients fail to respond to standard therapies (eg, corticosteroids). […] Bone marrow examination reveals normal or possibly increased numbers of megakaryocytes in an otherwise normal bone marrow sample.

• #17 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  The value of bone marrow evaluation for a diagnosis of ITP is unresolved. […] Biopsy in patients with ITP shows a normal-to-increased number of megakaryocytes in the absence of other significant abnormalities. […] In adults older than 60 years, biopsy is used to exclude myelodysplastic syndrome or leukemia. […] Unresponsiveness to standard treatment after 6 months is an indication for bone marrow aspiration.

• #18 Diagnostic approach to thrombocytopenia in adults – UpToDate

  https://www.uptodate.com/contents/diagnostic-approach-to-the-adult-with-unexplained-thrombocytopenia

  Diagnostic approach to thrombocytopenia in adults […] Here we discuss our approach to the adult with unexpected thrombocytopenia. This approach can be used by the primary care physician and the consulting hematologist. […] Thrombocytopenia may be associated with a variety of conditions, with clinical presentations ranging from asymptomatic to life-threatening bleeding (eg, in immune thrombocytopenia [ITP]) or thrombosis (eg, in heparin-induced thrombocytopenia [HIT]).

• #19 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  Immune thrombocytopenia (ITP) is a syndrome in which platelets become coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestration and phagocytosis by mononuclear macrophages. The resulting shortened life span of platelets in the circulation, together with incomplete compensation by increased platelet production by bone marrow megakaryocytes, results in a decreased number of circulating platelets (thrombocytopenia; see the image below). […] ITP is diagnosed by excluding other diseases; therefore, the absence of other findings from the peripheral smear is at least as important as the observed findings. […] No single laboratory result or clinical finding establishes a diagnosis of ITP; it is a diagnosis of exclusion. […] The differential diagnosis includes such other causes of thrombocytopenia as leukemia, myelophthisic marrow infiltration, myelodysplasia, aplastic anemia, and adverse drug reactions.

• #20 Overview of Platelet Disorders – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/overview-of-platelet-disorders

  Causes of thrombocytopenia can be classified by mechanism and include […] Decreased platelet production […] Increased splenic sequestration of platelets with normal platelet survival […] Increased platelet destruction or consumption (both immunologic and nonimmunologic causes) […] Dilution of platelets. […] Peripheral smear examination is important in patients with thrombocytopenia because automated platelet counts sometimes show pseudothrombocytopenia due to platelet clumping caused by the ethylenediaminetetraacetic acid (EDTA) reagent present in most blood collection tubes. […] Bone marrow aspiration is often indicated if the smear shows abnormalities other than thrombocytopenia, such as nucleated red blood cells (RBCs) or abnormal or immature white blood cells (WBCs). […] If the bone marrow is normal but the spleen is enlarged, increased splenic sequestration is the likely cause of thrombocytopenia.

• #21 Thrombocytopenia in Pregnancy | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/03/thrombocytopenia-in-pregnancy

  ABSTRACT: Obstetricians frequently diagnose thrombocytopenia in pregnant women because platelet counts are included with automated complete blood cell counts obtained during routine prenatal screening. […] Thrombocytopenia, defined as a platelet count of less than 150 10 9/L, is common and occurs in 712% of pregnancies at the time of delivery. […] Thrombocytopenia can result from a variety of physiologic or pathologic conditions, several of which are unique to pregnancy. […] Because of the increased recognition of maternal and fetal thrombocytopenia, there are numerous controversies about obstetric management of this condition. […] This Practice Bulletin is a targeted revision to reflect limited changes to information about new estimates for thrombocytopenia in pregnancy and the risk of recurrence of fetalneonatal alloimmune thrombocytopenia in subsequent pregnancies, and to provide new information on the level of thrombocytopenia that permits regional anesthesia.

• #22 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  Immune thrombocytopenia (ITP) is a rare blood disorder that affects how your blood clots. […] Immune thrombocytopenia (ITP) is a form of low platelet count, a condition that keeps your blood from clotting. […] Immune thrombocytopenia happens when your immune system clears your platelets from circulation and your platelet level goes down. […] Your healthcare provider will do a physical exam to check for bleeding on or under your skin. […] Providers may do the following tests: Complete blood count (CBC). […] If you’re at risk for HIV, hepatitis C or H. pylori, your provider may do tests for those infections. […] If you do need treatment, your healthcare provider may prescribe medications to boost your platelet count or keep your immune system from attacking your platelets. […] Your provider may recommend other steps like treating underlying infection. […] Contact your provider if you notice new bruises or petechia that may be signs that your condition is getting worse. […] Healthcare providers can treat the condition, but they can’t cure it.

• #23 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Primary immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder characterized by decreased platelet counts and an increased risk of bleeding. […] The diagnosis remains a clinical exclusion of other causes of thrombocytopenia. […] The international working group (IWG) on ITP and the American Society of Hematology (ASH) both updated their guidelines for the diagnosis and management of ITP in 2019. […] ITP remains a diagnosis of exclusion due to the lack of a “gold standard” diagnostic test. History taking, physical examination, complete blood count, and peripheral blood film assessment are the basic workups for suspected patients. […] Therefore, the diagnosis of ITP can be established with careful history taking and physical examination, as well as a review of peripheral blood smears and minimal further testing in most patients.

• #24 The Challenge for a Correct Diagnosis of Refractory Thrombocytopenia: ITP or MDS with Isolated Thrombocytopenia?

  https://www.mdpi.com/2072-6694/16/8/1462

  The aim of the present review is to summarize the main characteristics of immune thrombocytopenia (ITP) and to determine cases where persistent, isolated thrombocytopenia is misclassified as ITP. […] Immune thrombocytopenia (ITP) is an autoimmune disease characterized by isolated thrombocytopenia. It is diagnosed in patients with a platelet count below 100,000 per cubic millimeter in whom other causes of thrombocytopenia have been ruled out, and its diagnosis is generally one of exclusion. […] The aim of the present review is to summarize the pathologic conditions that are associated with thrombocytopenia—especially when this is presented as an isolated abnormality—and to emphasize cases where diagnosis of the underlying disease is unclear or confusing. […] The aim of the present review is to emphasize the differential diagnosis of isolated thrombocytopenia, which is much narrower but has been proved challenging, as rare mechanisms of isolated thrombocytopenia are sometimes overlooked.

• #25 Current Concepts in the Diagnosis and Management of Adult Primary Immune Thrombocytopenia: Our Personal View

  https://www.mdpi.com/1648-9144/59/4/815

  1. Primary immune thrombocytopenia (ITP) is an acquired blood disorder that causes a reduction in circulating platelets with the potential for bleeding. […] Despite advances in basic science, primary ITP remains a diagnosis of exclusion. […] The underlying cause of ITP and its pathophysiology is poorly understood. […] The diagnosis of ITP remains one of exclusion. Patients with suspected primary ITP undergo several investigations to exclude underlying diseases such as haematinic deficiencies, marrow infiltration, other autoimmune diseases, viral infections, and other disorders. If no abnormalities are found, and the only finding is of isolated thrombocytopenia (platelets < 100 × 10^9/L), a diagnosis of primary ITP is made. It is currently impossible to provide a positive diagnosis of ITP since there is no definitive diagnostic assay.

• #26 Immune thrombocytopenia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/138

  Full blood count and peripheral blood smear show isolated thrombocytopenia. […] Initial treatment options for newly diagnosed ITP include observation, or a corticosteroid and/or IVIG depending on platelet count and bleeding symptoms. […] Diagnostic investigations include FBC and peripheral blood smear as the 1st investigations to order. […] Investigations to consider include HIV serology, Helicobacter pylori breath test or stool antigen test, hepatitis C serology, thyroid function tests and antithyroid antibody tests, quantitative immunoglobulins, bone marrow biopsy/aspiration, and pregnancy test.

• #27

  https://journals.lww.com/bloodcoagulation/fulltext/2022/09000/primary_immune_thrombocytopenia__a__diagnosis_of.1.aspx

  Current diagnosis of primary immune thrombocytopenia (ITP) is presumptive, centered on excluding other causes of thrombocytopenia. […] The diagnosis of ITP is challenging because of the wide range of potential inherited and acquired causes of thrombocytopenia. […] We did not identify a diagnostic test that clinicians can use to confirm the diagnosis of ITP. […] In the absence of a diagnostic test of proven value in ITP, the clinician is best served by a comprehensive history and physical examination, complete blood count and review of the peripheral blood smear in evaluating thrombocytopenia. […] Devoid of a definitive confirmatory test, it is difficult to reliably establish the diagnosis without excluding congenital and acquired causes. […] Since the original description by Harrington and James W. Hollingsworth in 1950, there has been no significant advancement made in the diagnostic criteria, despite the fact that rapid strides have been made in the management of ITP.

• #28

  https://link.springer.com/article/10.1007/s12185-023-03672-1

  Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia due to accelerated platelet destruction and impaired platelet production. Diagnosis of ITP is still challenging because ITP has been diagnosed by exclusion. Exclusion of thrombocytopenia due to bone marrow failure is especially important in Japan because of high prevalence of aplastic anemia compared to Western countries. Hence, we propose a new diagnostic criteria involving the measurement of plasma thrombopoietin (TPO) levels and percentage of immature platelet fraction (RP% or IPF%); 1) isolated thrombocytopenia with no morphological evidence of dysplasia in any blood cell type in a blood smear, 2) normal or slightly increased plasma TPO level (cutoff), 3) elevated RP% or IPF% (upper limit of normal), and 4) absence of other conditions that potentially cause thrombocytopenia including secondary ITP. A diagnosis of ITP is made if conditions 1-4 are all met. Cases in which criterion 2 or 3 is not met or unavailable are defined as possible ITP, and diagnosis of ITP can be made mainly by typical clinical course. These new criteria enable us to clearly differentiate ITP from aplastic anemia and other forms of hypoplastic thrombocytopenia and can be highly useful in clinical practice for avoiding unnecessary bone marrow examination as well as for appropriate selection of treatments.

• #29

  https://link.springer.com/article/10.1007/s12185-023-03672-1

  Here, we have proposed new diagnostic criteria involving the measurement of plasma TPO levels and percentage of immature platelet fraction, which includes RP%. These biomarkers reflect the pathology of ITP, which is characterized by a shortened platelet lifespan associated with platelet destruction and relatively maintained platelet production. […] A diagnosis of ITP is made if conditions 1 – 4 above are all met. Cases in which criterion 2 or 3 is not met or unavailable are defined as possible ITP. A diagnosis of ITP can be made if the patient is glycoprotein (GP)-specific platelet-antibody positive, the patient demonstrates increased GP-specific antiplatelet antibody-producing B cells, or a typical clinical course. […] Measurement of the combination of immature platelet fraction and plasma TPO level in appropriate cases enable clear differentiation of ITP from hypoplastic thrombocytopenia, which has sometimes been difficult in the past. However, it remains crucial to rule out many other diseases by several screening examinations. Further evaluation of the validity of our diagnostic criteria is necessary.

• #30 Understanding Your ITP Diagnosis | PDSA

  https://pdsa.org/what-is-itp

  How is ITP diagnosed? ITP is a diagnosis of exclusion. Because there is no definitive test to diagnose ITP, your doctor will rule out other causes of low platelets, such as an underlying illness or medications you or your child may be taking. If no other cause is found, the diagnosis is often ITP. […] In addition to asking about your or your child’s medical history, your doctor will perform a physical exam and run one or more of the following tests: […] Complete blood count (CBC): A common blood test used to determine the number of blood cells, including platelets, in a sample of blood. […] Blood smear: This test is used to confirm the number of platelets observed in a complete blood count. […] Bone marrow exam: If blood tests show your platelet count is low, a bone marrow test may be recommended to show whether your bone marrow is making enough platelets; the American Society of Hematology doesn’t recommend this test for children with ITP. […] Learn more about the tests used to diagnose ITP and important information to share with your doctor for the correct diagnosis.

• #31 What Is Immune Thrombocytopenia (ITP): Symptoms, Causes, Diagnosis, Treatment, and Prevention | Everyday Health

  https://www.everydayhealth.com/immune-thrombocytopenia/guide/

  To diagnose ITP, your doctor will take a full medical history and perform a physical exam, looking for signs of bleeding and bruising. Other potential causes of low platelet count, such as certain medication or an underlying illness, will need to be ruled out, according to the Mayo Clinic. […] Certain blood tests can check your platelet count. According to the Cleveland Clinic, these include: A complete blood count, which checks your number of white blood cells, red blood cells, and platelets. A blood smear, in which your blood is put on a slide and a doctor checks your platelet levels. […] In rare cases, a bone marrow test may also be performed to check if your bone marrow is making enough platelets. Your doctor may also screen you for HIV, hepatitis C, or H. pylori. They may also order an antiplatelet antibody test, yet the accuracy of these tests varies.

• #32 SciELO Brazil – Thrombocytopenia: diagnosis with flow cytometry and antiplatelet antibodies Thrombocytopenia: diagnosis with flow cytometry and antiplatelet antibodies

  https://www.scielo.br/j/eins/a/qfpRypyMSjTpGskkbXtVxvp/?lang=en

  Objective: To identify antiplatelet antibodies by flow cytometry (direct method) in patients with thrombocytopenia. […] Flow cytometry immunophenotyping was done in 115 cases to identify platelet autoantibodies (direct method). […] Of the 115 cases (9.7%) submitted to immunophenotyping, the results were positive in 40% and the test was inconclusive in 5%. […] Antiplatelet autoantibodies when present help to diagnose idiopathic thrombocytopenic purpura. When absent, suggest other causes of thrombocytopenia. […] Flow cytometry immunophenotyping was carried out in 115 cases (9.7%) to identify the antiplatelet antibody (direct method), and it was positive in 40% of cases, negative in 55% and dubious in 5%. […] The antiplatelet antibody was positive in 76.9% of the ITP cases; and negative in 83.3% of the normal range cases. […] The antiplatelet antibody is a useful test, when positive, to confirm the diagnosis of idiopathic thrombocytopenic purpura, and very important, when negative, to rule out misdiagnoses.

• #33 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  However, the application of this diagnostic criterion will lead to misdiagnosis in a small proportion of patients with suspected ITP. […] To minimize the misdiagnosis rate, the Chinese ITP guidelines also recommend bone marrow examination and tests for antinuclear antibodies (ANAs), anti-phospholipid antibodies (APLAs), anti-thyroid antibodies, thyroid function, and coagulation parameters (prothrombin time, activated partial thromboplastin time, fibrinogen level, and D-dimer) as the basic evaluation. […] The presence of anti-GP autoantibodies is helpful to confirm the diagnosis of immune thrombocytopenia, while it cannot distinguish the primary from the secondary ITP. […] It should be emphasized that the response to treatments, especially intravenous immunoglobulin (IVIg), is of great value for the confirmation of ITP diagnosis.

• #34 Heparin-Induced Thrombocytopenia – HIT | Choose the Right Test

  https://arupconsult.com/content/heparin-induced-thrombocytopenia

  Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse effect of heparin treatment. Diagnosis of HIT is based on clinical assessment and laboratory results. Primary laboratory tests for HIT include immunologic assays, such as an enzyme-linked immunosorbent assay (ELISA), and functional, platelet-activation assays, such as the serotonin release assay (SRA). It is recommended that a clinical scoring system, such as the 4Ts system, be used to determine the pretest probability of HIT in a patient before laboratory testing is performed. […] The American Society of Hematology (ASH) recommends the 4Ts clinical scoring system, which is widely used to assess pretest probability for heparin-induced thrombocytopenia (HIT). This system takes into account the severity and timing of thrombocytopenia, the presence of thrombosis or other complication(s), and the likelihood of another cause of thrombocytopenia. Laboratory testing is typically not performed in patients with low scores (unless missing information could affect score reliability) due to the 4Ts systems high negative predictive value for HIT. Laboratory testing is performed in patients with intermediate or high 4Ts scores due to the systems poor positive predictive value. In patients who undergo laboratory testing, the combination of the clinical score and test results is used to determine the likelihood of HIT.

• #35 Heparin-Induced Thrombocytopenia – HIT | Choose the Right Test

  https://arupconsult.com/content/heparin-induced-thrombocytopenia

  In patients with an intermediate or high pretest probability of HIT, an enzyme-linked immunosorbent assay (ELISA) to detect heparin-platelet factor 4 (PF4) immunoglobulin G (IgG) antibodies is the first diagnostic step. If the ELISA is positive, testing with a functional assay, such as the serotonin release assay (SRA), may be helpful to confirm the diagnosis of HIT. […] Laboratory testing for HIT is appropriate to diagnose patients with thrombocytopenia after exposure to heparin, particularly those with an intermediate or high probability of HIT based on a clinical scoring system or risk factors.

• #36 Thrombocytopenia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0315/p612.html

  A history, physical examination, and laboratory studies can differentiate patients who require immediate intervention from those who can be treated in the outpatient setting. Treatment is based on the etiology and, in some cases, treating the secondary cause results in normalization of platelet counts. Consultation with a hematologist should be considered if patients require hospitalization, if there is evidence of systemic disease, or if thrombocytopenia worsens despite initial treatment. […] A low platelet count may be the only hematologic abnormality. In adults, thrombocytopenia is a platelet count less than 150 103 per L (150 109 per L). Cases are considered mild if counts are between 70 and 150 103 per L (70 to 150 109 per L) and severe if less than 20 103 per L (20 109 per L). Patients with a platelet count greater than 50 103 per L (50 109 per L) often are asymptomatic. Patients with a count from 30 to 50 103 per L (30 to 50 109 per L) rarely present with purpura, although they may have excessive bleeding with trauma. However, counts from 10 to 30 103 per L (10 to 30 109 per L) may cause bleeding with minimal trauma, and counts less than 10 103 per L increase the risk of spontaneous bleeding, petechiae, and bruising. Spontaneous bleeding (i.e., mucosal, intracranial, gastrointestinal, and genitourinary bleeding) is more likely in patients with platelet counts less than 5 103 per L (5 109 per L), and is considered a hematologic emergency.

• #37 Platelet Disorders – Thrombocytopenia | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/thrombocytopenia

  Thrombocytopenia is a condition that occurs when the platelet count in your blood is too low. […] A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood. […] To diagnose thrombocytopenia, your provider will ask about your medical and family history. They will also ask about your symptoms and do a physical exam to look for signs of bleeding. […] Your provider may order one or more of the following blood tests: Complete blood count (CBC): This test measures the levels of platelets and other blood cells in your blood. […] Blood smear: For this test, some of your blood is put on a slide. A microscope is used to look at your platelets. […] Bone marrow tests: These tests check whether your bone marrow is healthy. […] Treatment for thrombocytopenia depends on what caused it and whether you have any symptoms.

• #38 Low Platelet Count (Thrombocytopenia)

  https://www.healthline.com/health/thrombocytopenia

  A CBC test looks at the number of blood cells in your blood. It will tell your doctor if your platelet count is lower than it should be. […] Your doctor may also choose to perform a blood smear test, which looks at your blood under a microscope to see how the platelets look. […] If you are diagnosed with low platelet count, this information can help your healthcare professional treat your condition effectively. […] If the condition is mild, your doctor may choose to simply monitor you. […] If your low platelet count is more severe, you may need medical treatment. Treatment options may include: blood or platelet transfusions, changing medications that are causing a low platelet count, prescribing steroids, immune globulin, or other medicines that suppress your immune system, spleen removal surgery. […] If you think you may be experiencing symptoms of low platelet count, talk to a healthcare professional especially if youre experiencing serious symptoms, such as wounds or cuts that wont stop bleeding, or blood in your stools or urine.

• #39 Thrombocytopenia (Low Platelet Count): Causes, Symptoms, and Treatment Options

  https://www.webmd.com/a-to-z-guides/thrombocytopenia-symptoms-causes-treatments

  When you do need treatment, the goal is to get your platelet count up enough to prevent serious bleeding in your gut or brain. […] Your doctor can give you more blood or platelets to replace those you’ve lost. […] If other options don’t work, your doctor might suggest surgery to take out your spleen (splenectomy). […] If your low platelet counts are from TTP, plasma exchange can filter out the abnormal parts of your blood to help keep you from getting clots.

• #40 Overview of Platelet Disorders – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/overview-of-platelet-disorders

  Measurement of antiplatelet antibodies may be clinically useful in some patients to distinguish ITP from other causes of thrombocytopenia. […] In patients with thrombocytopenia or platelet dysfunction, medications that further impair platelet function, particularly aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), should not be given. […] Patients may require platelet transfusion, but transfusions are given only in limited situations. […] For example, platelet transfusion is the mainstay of therapy for patients with platelet dysfunction and active bleeding or for those in need of an invasive procedure. […] If decreased production is the cause of thrombocytopenia, transfusions, TPO-RA (eg, romiplostim, eltrombopag, avatrombopag), or antifibrinolytic agent (eg, aminocaproic acid, tranexamic acid) are reserved for patients with any of the following: Active bleeding, Severe thrombocytopenia (eg, platelet count 10,000/mcL), A need for an invasive procedure.

• #41 Thrombocytopenia and Platelet Function Disorders | Doctor

  https://patient.info/doctor/thrombocytopenia-and-platelet-function-disorders

  […] […] Managing thrombocytopenia3 […] Patients with modest isolated thrombocytopenia (platelet count 100-150109/L) without atypical features (eg, lymphadenopathy or fever) do not require referral to hospital, especially if the blood counts are stable. […] It is prudent occasionally to recheck the FBC in primary care to ensure that blood counts do not deteriorate or to be aware of any other condition becoming evident. […] If the results of the FBC are unchanged when repeated six weeks later, it is usually safe to extend the follow-up interval to several months. […] Patients must be aware that they should be seen straightaway if new symptoms such as bruising or bleeding occur. […] Indications for urgent referral include severe thrombocytopenia (20109/L), severe bleeding, and red cell fragments or blasts on the blood film.

• #42 Thrombocytopenia and Platelet Function Disorders | Doctor

  https://patient.info/doctor/thrombocytopenia-and-platelet-function-disorders

  Referral is also warranted if the patient has constitutional symptoms, bruising, minor bleeding, or abnormalities on examination (eg, lymph nodes or splenomegaly) or the blood film (eg, dysplastic changes). […] Referral to or discussion with a haematologist is reasonable if the platelet count is less than 100 x 109/L or the patient also has anaemia, neutropenia, or other changes in the blood count – eg, macrocytosis. […] Further management depends on the underlying cause.

• #43 Thrombocytopenia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK542208/

  Thrombocytopenia is a platelet count below the lower limit of normal, i.e., 150000/microliter (for adults). This activity reviews the etiology, evaluation, and management of thrombocytopenia and highlights the role of the interprofessional team in improving care for patients with this condition. […] Explain the appropriate history, physical, associated laboratory values, and evaluation of thrombocytopenia. […] Evaluation of patients with isolated thrombocytopenia includes obtaining a CBC, peripheral blood smear, HIV, and HCV tests. […] Bone marrow biopsy is indicated in conditions when the cause of thrombocytopenia is unclear, and when a hematologic disorder is suspected. […] Newly-diagnosed patients with thrombocytopenia are referred to a hematologist to confirm the diagnosis. In patients with unexplained thrombocytopenia, consulting hematologist is the recommendation. Immediate consultation is necessary for conditions like TTP, HUS, HIT, aplastic anemia, leukemia, and other bone marrow failure conditions.

• #44 Thrombocytopenia in Pregnancy | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/03/thrombocytopenia-in-pregnancy

  ABSTRACT: Obstetricians frequently diagnose thrombocytopenia in pregnant women because platelet counts are included with automated complete blood cell counts obtained during routine prenatal screening. […] Thrombocytopenia, defined as a platelet count of less than 150 10 9/L, is common and occurs in 712% of pregnancies at the time of delivery. […] Thrombocytopenia can result from a variety of physiologic or pathologic conditions, several of which are unique to pregnancy. […] Because of the increased recognition of maternal and fetal thrombocytopenia, there are numerous controversies about obstetric management of this condition. […] This Practice Bulletin is a targeted revision to reflect limited changes to information about new estimates for thrombocytopenia in pregnancy and the risk of recurrence of fetalneonatal alloimmune thrombocytopenia in subsequent pregnancies, and to provide new information on the level of thrombocytopenia that permits regional anesthesia.

• #45 Incidentally detected thrombocytopaenia in adults

  https://www.racgp.org.au/afp/2014/october/incidentally-detected-thrombocytopaenia-in-adults

  Thrombocytopenia in pregnancy deserves special consideration because, rarely, it may have disastrous consequences for the fetus. […] It is important to keep in mind that serious obstetric emergencies such as the HELLP syndrome (haemolysis, elevated liver enzymes and low platelets) and disseminated intravascular coagulopathy (DIC), may be underlying, albeit rare, causes of thrombocytopenia. […] The gold standard for confirming this diagnosis is a drug re-challenge but this is rather impractical. […] Thrombocytopenia may be seen in up to 76% of patients with chronic liver disease (CLD). […] The spleen normally sequesters 30-35% of the body’s platelets, but this can rise to 80-90% when it is enlarged, causing thrombocytopenia. […] There is an association between systemic autoimmune disorders such as systemic lupus erythematosus (SLE) and the antiphospholipid syndrome and thrombocytopenia.

• #46 Thrombocytopenia in the intensive care unit: diagnosis and management | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01447-x

  Thrombocytopenia is a common disorder in critically ill patients. The classic definition relies on an absolute platelet count below 150109/L. Alternatively, the definition has extended to a relative decrease in platelet count (typically within a range of 3050% decrease) from baseline, yet remaining above 150109/L. Thrombocytopenia may result from multiple mechanisms depending upon the underlying conditions and the current clinical setting. Regardless of the causes, thrombocytopenia accounts as an independent determinant of poor outcomes in critically ill patients, albeit often of unclear interpretation. Nevertheless, it is well established that thrombocytopenia is associated with an increased incidence of bleeding complications. […] Thrombocytopenia in critically ill patients is very frequent with various etiologies, and is associated with worsened prognosis, with or without bleeding complications.

• #47 Thrombocytopenia in the intensive care unit: diagnosis and management | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01447-x

  Thrombocytopenia in critically ill patients is usually multifactorial. The medical background, including comorbidities and ongoing acute conditions, most often allows an accurate assessment of the causes and mechanisms of thrombocytopenia without further extensive investigations. […] The diagnostic yield of bone marrow explorations in the ICU has been assessed through a prospective diagnostic study of critically ill patients with thrombocytopenia (here defined as platelet count100109/L or relative decrease by 30%). Bone marrow aspirates were performed in 208 patients. Megakaryocytes were present in 93% of bone marrow smears. However, the diagnostic and therapeutic yields of such a systematic approach were relatively poor and resulted in new information in 22% of cases, with further implications in management in 9% only.

• #48 Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China | Military Medical Research | Full Text

  https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-020-00244-w

  The dynamic patterns of thrombocytopenia are related to the characteristics of the disease. […] A rapid or continuous decline in platelet counts over a short period often indicates an adverse prognosis. […] It is important to understand the clinical background of thrombocytopenia in critical care patients to identify the cause. […] Comprehensive laboratory tests aid in the diagnosis of complicated thrombocytopenia. […] Routine bone marrow aspiration is not recommended for critical care patients with thrombocytopenia. […] Peripheral blood smears can help diagnose thrombocytopenia in critical care patients. […] For thrombocytopenia accompanied by thromboembolic symptoms, differential diagnosis is required for conditions such as DIC, TMA, HELLP syndrome, APS, HIT, and PNH. […] Platelet function must be evaluated in case of thrombocytopenia.

• #49 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Primary immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder characterized by decreased platelet counts and an increased risk of bleeding. […] The diagnosis remains a clinical exclusion of other causes of thrombocytopenia. […] The international working group (IWG) on ITP and the American Society of Hematology (ASH) both updated their guidelines for the diagnosis and management of ITP in 2019. […] ITP remains a diagnosis of exclusion due to the lack of a “gold standard” diagnostic test. History taking, physical examination, complete blood count, and peripheral blood film assessment are the basic workups for suspected patients. […] Therefore, the diagnosis of ITP can be established with careful history taking and physical examination, as well as a review of peripheral blood smears and minimal further testing in most patients.

• #50

  https://haematologica.org/article/view/haematol.2021.279513

  This article summarizes our approach to the diagnosis of immune thrombocytopenia (ITP), its secondary forms, and choice of second-line treatment options. […] Immune thrombocytopenia (ITP) is a complicated disease because of its heterogeneity and lack of diagnostic markers making selection of treatment difficult. […] The management of ITP becomes more complicated if other findings arise, if patients do not respond to steroids, or if patients continue to require treatment. […] This review focuses on the initiation of second-line treatment reviewing the pros and cons of different agents utilizing a case-based approach by first exploring ITP in a young female and continuing throughout her pregnancy. […] The stability of her blood counts after initial treatment excludes cyclic thrombocytopenia which is an often-forgotten form of inherited thrombocytopenia.

• #51 Immune-Mediated Thrombocytopenia

  https://vhc.missouri.edu/small-animal-hospital/small-animal-internal-medicine/diseases-and-treatments/immune-mediated-thrombocytopenia/

  Immune-mediated thrombocytopenia (ITP) is an example of an auto-immune disease where the immune system destroys platelets within the body when they are misrecognized. […] Diagnosing an animal with platelet disease begins with a thorough history and physical examination. […] A blood sample will be obtained to perform a platelet count. […] A diagnosis of ITP is typically made after excluding other causes for a low platelet count.

• #52

  https://journals.lww.com/bloodcoagulation/fulltext/2022/09000/primary_immune_thrombocytopenia__a__diagnosis_of.1.aspx

  Assays for antibodies to specific platelet glycoproteins are not routinely recommended as platelet-associated IgG is elevated in both immune and nonimmune thrombocytopenia. […] The presence of APLA does not appear to affect the response to treatment in ITP. […] Overall, direct antiglobulin testing or testing for ANA, antiphospholipid antibodies, antithyroid antibodies, or thyroid function tests may exclude other causes of thrombocytopenia when clinical suspicion exists. […] However, the evidence to support this concept is highly variable. […] In a prospective study of 353 cases, bone marrow examination in ITP revealed normal hematopoietic elements. […] The authors in this study concluded that routine bone marrow examination may not be required in the diagnostic work-up of ITP. […] The diagnosis of ITP needs great caution and follow-up as this may convert to other immune-mediated disorders over time.

• #53 Incidentally detected thrombocytopaenia in adults

  https://www.racgp.org.au/afp/2014/october/incidentally-detected-thrombocytopaenia-in-adults

  With the advent of automated counters, low platelet counts are a common incidental finding. […] This article provides general practitioners with an approach to differentiating the benign from the life-threatening causes of thrombocytopenia using routine pathology testing in adults. […] There are no specific laboratory tests that can conclusively identify the mechanism of thrombocytopenia a thorough history, clinical examination, and blood results remain the initial means of diagnosis. […] Confirm that thrombocytopenia is isolated (ie. the full blood evaluation is otherwise normal and there are no red or white blood cell abnormalities on a peripheral blood film. […] The previous blood results should be reassessed. A low platelet count may be normal for the patient and not represent illness.

• #54 Evaluation of thrombocytopenia – Differential diagnosis of symptoms | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/795

  Thrombocytopenia is defined as a low circulating platelet count (150,000 per microliter). […] The differential diagnosis for a patient with new thrombocytopenia is broad and includes primary bone marrow disorders, chronic liver disease, infection, drug-related adverse effects, occult malignancy, and autoimmune/rheumatologic conditions. […] A complete history, physical exam, review of the CBC, and peripheral smear are necessary to narrow down the differential diagnosis of thrombocytopenia. It is important to exclude artifact or pseudothrombocytopenia. […] Bone marrow biopsy is performed if all other studies are inconclusive. […] Primary ITP is diagnosed when there is no identifiable underlying condition following comprehensive patient evaluation.

• #55 Thrombocytopenia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0315/p612.html

  A systematic approach should be used to evaluate incidental thrombocytopenia. During the patient history, physicians should inquire about easy bruising or petechiae, melena, rashes, fevers, and bleeding. They also should inquire about medication use, immunizations, recent travel, transfusion history, family history, and medical history. […] A peripheral blood smear can provide diagnostic information on a variety of white blood cell disorders, hemolytic anemias, and thrombocytopenia. A blood smear should be obtained during the initial evaluation. […] The findings of isolated thrombocytopenia in an outpatient setting have prognostic implications. A prospective study evaluated the long-term outcomes of patients with incidental thrombocytopenia. The study followed 217 persons with platelet counts from 100 to 150 103 per L (100 to 150 109 per L) over a 10-year period. In 64 percent of patients, platelet counts normalized or remained stable. The probability of developing immune thrombocytopenic purpura or an autoimmune disorder was approximately 7 and 12 percent, respectively. Four cases of myelodysplastic syndrome were diagnosed (2 percent), all of which were in older patients.

• #56 Thrombocytopenia and Platelet Function Disorders | Doctor

  https://patient.info/doctor/thrombocytopenia-and-platelet-function-disorders

  […] […] Managing thrombocytopenia3 […] Patients with modest isolated thrombocytopenia (platelet count 100-150109/L) without atypical features (eg, lymphadenopathy or fever) do not require referral to hospital, especially if the blood counts are stable. […] It is prudent occasionally to recheck the FBC in primary care to ensure that blood counts do not deteriorate or to be aware of any other condition becoming evident. […] If the results of the FBC are unchanged when repeated six weeks later, it is usually safe to extend the follow-up interval to several months. […] Patients must be aware that they should be seen straightaway if new symptoms such as bruising or bleeding occur. […] Indications for urgent referral include severe thrombocytopenia (20109/L), severe bleeding, and red cell fragments or blasts on the blood film.

• #57 Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China | Military Medical Research | Full Text

  https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-020-00244-w

  There are many causes of thrombocytopenia. To treat thrombocytopenia, clinicians must first eliminate or control the factors inducing thrombocytopenia as soon as possible. […] Vitamin B12 and folic acid can treat thrombocytopenia caused by vitamin B12 and folic acid deficiency. […] Thrombopoietic drugs can be used to treat bone marrow suppressive thrombocytopenia. […] Anticoagulation therapy is required when thrombocytopenia is combined with a prethrombotic state or a thrombus is already formed. […] Antiplatelet therapy should be administered with caution after a comprehensive evaluation of the risk of bleeding when thrombocytopenia is combined with a prethrombotic state or a thrombus is already formed. […] Plasma exchange eliminates abnormal immune antibodies and reduces platelet destruction. […] Splenectomy should be used with caution for thrombocytopenia. […] Influencing factors of thrombocytopenia need to be actively controlled during ECLS.

• #58 Thrombocytopenia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/thrombocytopenia.html

  Thrombocytopenia is present in 64% to 84% of patients with chronic hepatic disease. […] The primary mechanism for thrombocytopenia is decreased hepatic synthesis of thrombopoietin, which is essential for the production of platelets. […] Recommended minimum platelet counts for patients undergoing surgical or invasive procedures are variable and based on limited scientific evidence. The American Society of Clinical Oncology guideline recommends a minimum platelet count of 40 to 50 103 per L, and the AABB (formerly known as the American Association of Blood Banks) recommends greater than 50 103 per L for most major invasive procedures and surgeries. […] In addition to patients undergoing procedures, platelet transfusions are often used in patients with severe thrombocytopenia to treat or prevent acute hemorrhage.

• #59 Thrombocytopenia in the intensive care unit: diagnosis and management | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01447-x

  The platelet count transfusion threshold to secure invasive procedures remains based on a low level of evidence. The ESICM guidelines recommend no transfusion before invasive procedure when the platelet count is above 100109/L and before central venous catheter (CVC) insertion and percutaneous tracheotomy when the platelet count is between 50109/L and 100109/L.

• #60 Overview of Platelet Disorders – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/overview-of-platelet-disorders

  Measurement of antiplatelet antibodies may be clinically useful in some patients to distinguish ITP from other causes of thrombocytopenia. […] In patients with thrombocytopenia or platelet dysfunction, medications that further impair platelet function, particularly aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), should not be given. […] Patients may require platelet transfusion, but transfusions are given only in limited situations. […] For example, platelet transfusion is the mainstay of therapy for patients with platelet dysfunction and active bleeding or for those in need of an invasive procedure. […] If decreased production is the cause of thrombocytopenia, transfusions, TPO-RA (eg, romiplostim, eltrombopag, avatrombopag), or antifibrinolytic agent (eg, aminocaproic acid, tranexamic acid) are reserved for patients with any of the following: Active bleeding, Severe thrombocytopenia (eg, platelet count 10,000/mcL), A need for an invasive procedure.

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