​Symptoms and Signs – Differential Diagnosis of Thrombocytopenia
INCREASED DESTRUCTION
Immunologic
• Drugs: quinine, quinidine, digitalis, procainamide, thiazide diuretics, sulfonamides, phenytoin, aspirin, penicillin, heparin, gold, meprobamate, sulfa drugs, phenylbutazone, nonsteroidal anti-inflammatory drugs (NSAIDs), methyldopa, cimetidine, furosemide, isoniazid (INH), cephalosporins, chlorpropamide, organic arsenicals, chloroquine, platelet glycoprotein IIb/IIIa receptor inhibitors, ranitidine, indomethacin, carboplatin, ticlopidine, clopidogrel
• Idiopathic thrombocytopenic purpura (ITP)
• Transfusion reaction: transfusion of platelets with plasminogen activator (PLA) in recipients without PLA-1
• Fetal/maternal incompatibility
• Collagen-vascular diseases (e.g., systemic lupus erythematosus [SLE])
• Autoimmune hemolytic anemia
• Lymphoreticular disorders (e.g., chronic lymphocytic leukemia [CLL])
Nonimmunologic
• Prosthetic heart valves
• Thrombotic thrombocytopenic purpura (TTP)
• Sepsis
• Disseminated intravascular coagulation (DIC)
• Hemolytic-uremic syndrome (HUS)
• Giant cavernous hemangioma
DECREASED PRODUCTION
• Abnormal marrow
• Marrow infiltration (e.g., leukemia, lymphoma, fibrosis)
• Marrow suppression (e.g., chemotherapy, alcohol, irradiation)
• Hereditary disorders
• Wiskott-Aldrich syndrome: X-linked disorder characterized by
thrombocytopenia, eczema, and repeated infections
• May-Hegglin anomaly: increased megakaryocytes but
ineffective thrombopoiesis
• Vitamin deficiencies (e.g., vitamin B12, folic acid)
HYPERSPLENISM; SPLENIC SEQUESTRATION;
DILUTIONAL, AS A RESULT OF MASSIVE TRANSFUSION