Thrombocytopenia clinical presentation

Larned ZL, O Shea SI, Ortel TL. Heparin-induced thrombocytopenia clinical presentations and therapeutic management. Clin Adv Hematol Oncol. 2003 1 356-364. 

Clinical presentation and diagnosis. Clinically, patients report rapid weight gain with increased abdominal girth. Jaundice, liver enlargement and varying amounts of ascites are found on examination. Elevated liver enzymes, transient thrombocytopenia and elevated CA-125 have been observed... 

TTP occurs in approximately 1000 individuals in North America every year. The diagnosis is mainly clinical and suspected when patients present with any combination of renal insufficiency, thrombocytopenia, and central nervous system symptomatology (145,146). Altered mental status,... 

A third variety, so-called delayed-onset heparin-induced thrombocytopenia has also been described in several reports. In 12 patients, recruited from secondary and tertiary care hospitals, thrombocytopenia and associated thrombosis occurred at a mean of 9.2 (range 5-19) days after the withdrawal of heparin nine received additional heparin, with further falls in platelet counts (32). In a retrospective case series, 14 patients, seen over a 3-year period, developed thromboembolic complications a median of 14 days after treatment with heparin (33). The emboli were venous (n — 10), or arterial (n — 2), or both (n — 2) of the 12 patients with venous embolism, 7 had pulmonary embolism. Platelet counts were mildly reduced in all but two patients at the time of the second presentation. On readmission, 11 patients received therapeutic heparin, which worsened their clinical condition and further reduced the platelet count. 

Hemolytic-uremic syndrome presents as a Coombsnegative microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency, and the outcome is often fatal. The underlying pathology is thought to be vascular endothelial damage. It occurs 4-7 months after the start of chemotherapy. Blood transfusion can cause clinical deterioration in those affected (9). Histology of... 

Laboratory abnormalities of routine tests most commonly involve tests of liver function, and patients with acute Q fever may present with a clinical picture of acute hepatitis. Depending on the locale, reported elevations of aspartate aminotransferase, alanine transferase, or both, in the range of 2- to 3-fold higher than the upper limit of normal, are observed in 50% to 75% of patients, while elevation of the alkaline phosphatase is observed in 10% to 15% of patients. The total bilirubin can be expected to be elevated in 10% to 15% of patients with acute Q fever. The white blood cell count is usually normal the erythrocyte sedimentation rate is elevated in one third of patients.65 Mild anemia or thrombocytopenia may also be observed. 

In several instances severe bone marrow depression occurred, characterized by neutropenia and thrombocytopenia. The clinical chemistry profile of these cases revealed hypocholesterolemia, hyperuricemia, and hypoproteinemia. In a few cases, slight disturbance of liver function was found with mild elevations of aminotransferases. In male subjects, azoospermia or abnormal spermatozoa and reduced motility of spermatozoa were observed. Some cases presented with postexposure lacrimation, hyperemia, and edema of the conjunctiva. There were instances of protracted reduction in visual capacity and reports of retinal abnormalities [45]. Lymphocytes from exposed subjects showed a considerable number of chromosomal aberrations [46,47]. 

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