Common tests & procedures
These include:
- Complete blood count (CBC): A CBC is a blood test that measures the number of white blood cells, red blood cells, and platelets in the blood. ...
- Blood smear: In a blood smear, a sample of blood is taken and placed on a slide. ...
- Bone marrow biopsy: This is not a test often done for ITP, but can be useful in some cases. ...
What tests can diagnose thrombocytopenia?
- Headache
- Dizziness or lightheadedness
- Chest pain
- Weakness
- Numbness or tingling of the hands and feet
What are the risks of having thrombocytopenia?
These include:
- Alcohol use disorder and alcoholism.
- Autoimmune disease which causes ITP. ...
- Bone marrow diseases, including aplastic anemia, leukemia, certain lymphomas and myelodysplastic syndromes.
- Cancer treatments like chemotherapy and radiation therapy.
- Enlarged spleen caused by cirrhosis of the liver or Gaucher disease. ...
What factors lead to thrombocytopenia?
A count lower than 150,000 platelets per microlitre of blood is considered to be thrombocytopenia, which means a lower than normal platelet count. Below 50,000 is a seriously low platelet count. Below 10,000 is considered severe thrombocytopenia, with a risk of internal bleeding. What is a high platelet count?
What is considered severe thrombocytopenia?
What doctor diagnoses thrombocytopenia?
Your doctor will diagnose thrombocytopenia based on your medical history, a physical exam, and test results. A hematologist also may be involved in your care. This is a doctor who specializes in diagnosing and treating blood diseases and conditions.
How to do a bone marrow biopsy?
A bone marrow biopsy often is done right after an aspiration. For this test, your doctor removes a sample of bone marrow tissue through a needle. He or she examines the tissue to check the number and types of cells in the bone marrow.
What is the purpose of blood smear?
Blood Smear. A blood smear is used to check the appearance of your platelets under a microscope. For this test, a small amount of blood is drawn from a blood vessel, usually in your arm.
How to check if your spleen is enlarged?
Your doctor also may suggest an ultrasound to check your spleen. An ultrasound uses sound waves to create pictures of your spleen. This will allow your doctor to see whether your spleen is enlarged.
What does CBC mean in blood work?
A complete blood count (CBC) measures the levels of red blood cells, white blood cells, and platelets in your blood . For this test, a small amount of blood is drawn from a blood vessel, usually in your arm. If you have thrombocytopenia, the results of this test will show that your platelet count is low.
What does a doctor check for?
Your doctor will do a physical exam to look for signs and symptoms of bleeding, such as bruises or spots on the skin. He or she will check your abdomen for signs of an enlarged spleen or liver. You also will be checked for signs of infection, such as a fever.
What are the factors that affect platelets?
Your doctor may ask about factors that can affect your platelets, such as: The medicines you take, including over-the-counter medicines and herbal remedies, and whether you drink be verages that contain quinine. Quinine is a substance often found in tonic water and nutritional health products.
What is the blood count of a person with thrombocytopenia?
A platelet count that falls below the lower limit of normal, i.e., 150000/microliter (for adults) is defined as thrombocytopenia. Platelets are blood cells that help in blood clotting and wound healing — risks associated with thrombocytopenia range from no risk at all to bleeding risks and thrombosis. The correlation of severity of thrombocytopenia and bleeding risk is uncertain. Spontaneous bleeding can occur with a platelet count under 10000/microliter and surgical bleeding with counts below 50000/microL. Thrombocytopenia is associated with risk of thrombosis in conditions like heparin-induced thrombocytopenia (HIT), antiphospholipid antibody syndrome (APS), disseminated intravascular coagulation (DIC), thrombotic microangiopathy (TMA), paroxysmal nocturnal hemoglobinuria (PNH).
What is the platelet count of thrombocytopenia?
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.
What is TTP in medical terms?
Thrombotic thrombocytopenic purpura (TTP), a condition manifested by fever, renal failure, thrombocytopenia, microangiopathic hemolytic anemia with or without neurologic manifestations
What causes decreased platelet production in the bone marrow?
Systemic conditions like nutrient deficiencies (folate, vitamin B12), sepsis, myelodysplastic syndrome impairs platelet production in the bone marrow - these conditions also associated with decreased production of other cell lines leading to anemia and leukopenia
When is bone marrow biopsy indicated?
Bone marrow biopsy is indicated in conditions when the cause of thrombocytopenia is unclear, and when a hematologic disorder is suspected.
What are anti-platelets in ITP?
Anti-platelets antibodies are present in primary ITP, drug-induced ITP, lymphoproliferative disorders, autoimmune conditions like SLE and in chronic infections like HEP C, HIV, and Helicobacter pylori.
Where is the most platelet mass?
In normal individuals, one-third of platelet mass is in the spleen. In conditions that cause splenomegaly and increases spleen congestion (cirrhosis) results in increased platelet mass in spleen and a decrease in circulating platelets.
What is thrombocytopenia?
Thrombocytopenia is a condition that occurs when the platelet count in your blood is too low. Platelets are tiny blood cells that are made in the bone marrow from larger cells. When you are injured, platelets stick together to form a plug to seal your wound. This plug is called a blood clot.
What are the symptoms?
Bleeding causes the main symptoms of thrombocytopenia. Symptoms can appear suddenly or over time. Mild thrombocytopenia often has no symptoms. Many times, it is found during a routine blood test.
How is it diagnosed?
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.
What causes thrombocytopenia?
Thrombocytopenia can be inherited or acquired. “Inherited” means your parents pass the gene for the condition to you. “Acquired” means you are not born with the condition, but you develop it later. Sometimes the cause of thrombocytopenia is not known.
How is thrombocytopenia treated?
Treatment for thrombocytopenia depends on what caused it and whether you have any symptoms. If you have mild thrombocytopenia, you may not need treatment. A fully normal platelet count is not necessary to prevent serious bleeding, even with serious cuts or accidents.
What health problems can thrombocytopenia cause?
Without proper treatment, thrombocytopenia can cause serious bleeding. This can happen both inside your body and out of your skin. It can be life-threatening. Learn how you can manage thrombocytopenia to help prevent complications.
What is the physical examination for thrombocytopenia?
Physical examination should focus on the location and severity of bleeding risk and other abnormalities that can help in the diagnosis of the thrombocytopenia, such as the presence of organomegaly or skeletal abnormalities. Patients with thrombocytopenia typically experience mucocutaneous bleeding. The presence of joint or extensive soft tissue bleeding suggests the presence of coagulation abnormalities, such as occurs in DIC. The presence of an ischemic limb of skin necrosis should raise suspicion of heparin-induced thrombocytopenia (HIT).
What is thrombocytopenia in hematology?
Thrombocytopenia is a common hematologic finding with variable clinical expression. A low platelet count may be the initial manifestation of infections such as HIV and hepatitis C virus or it may reflect the activity of life-threatening disorders such as the thrombotic microangiopathies. A correct identification of the causes of thrombocytopenia is crucial for the appropriate management of these patients. In this review, we present a systematic evaluation of adults with thrombocytopenia. The approach is clearly different between outpatients, who are frequently asymptomatic and in whom we can sometimes indulge in sophisticated and relatively lengthy investigations, and the dramatic presentation of acute thrombocytopenia in the emergency department or in the intensive care unit, which requires immediate intervention and for which only a few diagnostic tests are available. A brief discussion of the most common etiologies seen in both settings is provided.
What are the mechanisms of decreased platelet count?
The major mechanisms for a reduced platelet count are decreased production and increased destruction of platelets . Typical examples of the former are the BM failure syndromes (eg, aplastic anaemia, myelodysplastic syndromes, and chemotherapy-induced thrombocytopenia), whereas increased destruction is seen in conditions such as disseminated intravascular coagulation (DIC) and the thrombotic microangiopathies. Two less common mechanisms are platelet sequestration and hemodilution. Platelet sequestration is seen in congestive splenomegaly due to portal hypertension and is characterized by redistribution of platelets from the circulating pool to the splenic pool. 4 Hemodilution is seen in patients who have suffered a massive hemorrhage and have received colloids, crystalloids, and platelet-poor blood products.
How long does it take for a platelet count to decrease after taking a drug?
The decrease of the platelet count typically occurs within 2-3 days (sometimes a few hours) of taking a drug that has been taken previously or 1-3 weeks after starting a new drug.
What is the normal platelet count for thrombocytopenia?
Thrombocytopenia is defined as a platelet count below the 2.5th lower percentile of the normal platelet count distribution. Results of the third US National Health and Nutrition Examination Survey (NHANES III) support the traditional value of 150 × 10 9 /L as the lower limit of normal. 1 However, platelet counts between 100 and 150 × 10 9 /L do not necessarily indicate disease if they have been stable for more than 6 months, 2 and the adoption of a cutoff value of 100 × 10 9 /L may be more appropriate to identify a pathologic condition. 3 Furthermore, it is now appreciated that in many non-Western countries, the lower threshold of the normal platelet count is lower than 150 × 10 9 /L. 3
Why is my platelet count low during pregnancy?
In hospitalized and critically ill patients, the diagnosis of thrombocytopenia is often challenging due to the presence of several potential etiologies, including drugs and infections.
How long does it take for a thrombocytopenia to resolve?
To support a diagnosis of GT, women should have no past history of thrombocytopenia (except during a previous pregnancy), and the thrombocytopenia should resolve spontaneously within 1-2 months after delivery.
How do you know if you have thrombocytopenia?
Some people with mild cases of thrombocytopenia don’t have symptoms. Often, one of the first signs is a cut or nosebleed that won’t stop bleeding. Other signs of low platelet count include:
What is thrombocytopenia in blood?
What is thrombocytopenia? Thrombocytopenia (THROM-bo-sigh-toe-PEE-ne-ah) occurs when your blood platelet count is low. Platelets are also called thrombocytes. This type of blood cell clumps together to form blood clots to help stop bleeding at the site of a cut or wound. Another name for a blood clot is thrombus.
How to tell if your platelet count is low?
Often, one of the first signs is a cut or nosebleed that won’t stop bleeding. Other signs of low platelet count include: Bleeding gums. Blood in stool (black, tarry-looking), urine (hematuria) or vomit. Heavy menstrual periods. Petechiae (tiny red or purple dots on the lower legs that resemble a rash).
What is the name of the tissue that makes blood clots?
Another name for a blood clot is thrombus. Bone marrow is the soft, spongy tissue inside bones that makes all blood cells including platelets. People who have thrombocytopenia don’t have enough platelets to form a blood clot. If you get a cut or other injury, you may bleed too much and the bleeding can be hard to stop.
How long does a platelet transfusion last?
Platelets are transfused only if the platelet count is extremely low. (Transfused platelets only last about three days in the circulation.)
What causes ITP?
Autoimmune disease which causes ITP. ITP is sometimes associated with other autoimmune conditions such as lupus. Bone marrow diseases , including aplastic anemia, leukemia, certain lymphomas and myelodysplastic syndromes. Cancer treatments like chemotherapy and radiation therapy.
How many pregnant women have thrombocytopenia?
Thrombocytopenia can affect people of all ages, races and genders. For unknown reasons, approximately 5% of pregnant women develop mild thrombocytopenia right before childbirth.
What is secondary thrombocytopenic testing?
Secondary testing should be performed based on the patient’s 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). 1
How long does it take for thrombocytopenia to manifest after platelet transfusion?
Associated with severe thrombocytopenia that manifests 5-14 days after platelet transfusion
What is primary immune thrombocytopenia?
Primary immune thrombocytopenia, previously referred to as idiopathic thrombocytopenic purpura, is a diagnosis of exclusion. Patients with primary immune thrombocytopenia may demonstrate reduced platelet counts without an obvious underlying cause.
What does a peripheral smear show?
The peripheral smear review can also provide clues. For example, the presence of schistocytes may indicate a microangiopathic process, such as DIC or thrombotic thrombocytopenic purpura (TTP), but is not a sensitive or specific finding for these disorders.
What is DIC testing?
Testing for DIC, an acquired condition that results in widespread clotting (particularly in small vessels) and consumption of coagulation factors and platelets, should be performed in all hospitalized patients with thrombocytopenia. Refer to the DIC ARUP Consult topic for additional information about testing for this condition.
Is DIC a thrombotic microangiopathy?
No, certain disorders such as disseminated intravascular coagulation (DIC), thrombotic microangiopathies (TMAs) such as thrombotic thrombocytopenic purpura (TTP), and heparin-induced thrombocytopenia (HIT) are associated with increased thrombotic risk. Thrombocytopenia can result from a large number of underlying disorders, and close correlation with clinical and laboratory information is necessary for accurate diagnosis and assessment of bleeding or thrombotic risk.
Is thrombocytopenia a underlying disorder?
Thrombocytopenia can result from a large number of underlying disorders, and close correlation with clinical and laboratory information is necessary for accurate diagnosis and assessment of bleeding or thrombotic risk.
Initial Evaluation
Thrombocytopenia can result from decreased platelet production, increased platelet consumption, or sequestration ( Table 1 3 – 6 ). Common etiologies with clinical findings and suggested treatment are listed in Table 2, 7 – 14 and clinical considerations to aid in diagnosis are listed in Table 3.
Long-term Outcomes of Incidental Thrombocytopenia
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 × 10 3 per μL (100 to 150 × 10 9 per L) over a 10-year period.
Factitious Thrombocytopenia
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. 3 Causes include use of abciximab (Reopro) or ethylenediaminetetraacetic acid–dependent agglutinins.
Management
A suggested algorithm for the management of thrombocytopenia is shown in Figure 1. 4 Symptomatic patients require immediate evaluation.
Activity Participation and Invasive Procedures
General recommendations for activity participation have been based on historical data from patients with chronic severe thrombocytopenia. 39, 40 A platelet count greater than 50 × 10 3 per μL is adequate for hemostasis and is unlikely to be clinically recognized.
What is the test used to determine if you have TTP?
Platelet Count. This test counts the number of platelets in a blood smear. People who have TTP have a lower than normal number of platelets in their blood. This test is used with the blood smear to help diagnose TTP.
How to test for TTP?
For this test, a sample of blood is drawn from a vein, usually in your arm. Some of your blood is put on a glass slide. A microscope is then used to look at your red blood cells. In TTP, the red blood cells are torn and broken.
Why do you need a blood test for TTP?
In TTP, hemolytic anemia occurs because red blood cells are broken into pieces as they try to squeeze around blood clots.
What does TTP mean in blood work?
This test measures the number of red blood cells, white blood cells, and platelets in your blood. For this test, a sample of blood is drawn from a vein, usually in your arm. If you have TTP, you'll have a lower than normal number of platelets and red blood cells ( anemia ).
What doctor treats TTP?
If TTP is suspected or diagnosed, a hematologist will be involved in your care. A hematologist is a doctor who specializes in diagnosing and treating blood disorders.
What causes TTP in a lab?
A lack of activity in the ADAMTS13 enzyme causes TTP. For this test, a sample of blood is drawn from a vein, usually in your arm. The blood is sent to a special lab to test for the enzyme's activity.
Why is bilirubin high in TTP?
If you have TTP, your bilirubin level may be high because your body is breaking down red blood cells faster than normal.
