Thrombocytopenia diagnosis

Januzzi JL Jr, Jang IK. Heparin induced thrombocytopenia Diagnosis and contemporary antithrombin management. J Thromb Thrombol 1999 7 259-264. 

Alaraj A, Wallace A, Tesoro E, Ruland S, Amin-Hanjani S, Charbel FT, Aletich V. Heparin induced thrombocytopenia diagnosis and management. J Neurointerv Surg 2010 2(4) 371-8. 

W. L. "Prospects for Radiographic Intrauterine Diagnosis -The Syndrome of Thrombocytopenia with Absent Radii". N. 

Differential Diagnosis Thrombocytopenia (a condition in which there is an abnormally small number of platelets in the circulating blood) and an elevated aspartate aminotransferase (AST) may provide a clue to suggest CCHF is the culprit in the febrile (denoting or relating to fever) patient seen early in the course of infection. Other viral hemorrhagic fevers, meningococcemia, rickettsial diseases, and similar conditions may resemble full-... 

Laboratory monitoring includes complete blood count, especially the absolute neutrophil count, platelet count, and the appearance of the peripheral smear. Thrombocytopenia induced by ticlopidine is occasionally unrelated to TTP. Further investigate for a diagnosis of TTP with the occurrence of any acute, unexplained reduction in hemoglobin or platelet count. Discontinue ticlopidine if there are laboratory signs of TTP or the neutrophil count is less than 1200/mm. ... 

F. Role in therapy Lepirudin is a thrombin-inhibitor indicated for use in the treatment of adults with heparin-induced thrombocytopenia (HIT) type II diagnosis... 

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,... 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

Whenever pseudothrombocytopenia is suspected, for example in the case of unexpected thrombocytopenia without signs of bleeding, the diagnosis can be confirmed by finding normal platelet counts immediately after drawing the blood specimen or by examination of a blood smear. When serial counts are made, the number of platelets falls linearly with time. Pseudothrombocytopenia is usually associated with a normal mean platelet volume, whereas true thrombocytopenia is associated with a reduced mean platelet volume (28). 

Type II thrombocytopenia is probably an immune-mediated phenomenon, a fact that has been the subject of much specific investigation (27,37 2). It has been proposed that the diagnosis should depend on two criteria the association of one or more clinical events and laboratory evidence of a heparin-dependent immunoglobulin (36). 

Laboratory diagnosis of heparin-induced thrombocytopenia can be made either using functional tests (demonstration of platelet activation of normal donor platelets in vitro by the patient s serum in the presence of heparin) or by screening for antibodies (27,43). The duration of the antibody response can vary from weeks to months up to 1 year. The two types of tests are complementary both should be used when the reported results of either are inconsistent with the clinical problem. 

Two women aged 24 and 44 years, whose primary diagnosis was relapsing multiple sclerosis, developed renal impairment and a thrombotic thrombocytopenic pur-pura-like syndrome within 2-4 weeks after starting interferon beta-la (44). Thrombocytopenia and renal function normalized in the first patient, whereas the second patient had thrombotic angiopathy on renal biopsy and required dialysis while awaiting renal transplantation. 

Primary Hemostasis, Cellular Components Platelet Count Direct determination of the number of platelets per unit volume Platelet number Diagnosis of thrombocytopenia Generally none, but insensitive to defective function... 

LMWHs exhibit nearly 100% cross-reactivity with heparin antibodies in vitroT Therefore, the LMWHs should be avoided in patients with an established diagnosis or history of HIT. Platelet counts must be monitored periodically in all patients receiving a LMWH, and thrombocytopenia of any degree should be evaluated promptly. 

Rutherford CJ, Erenkel EP. Thrombocytopenia issues in diagnosis and therapy. Med Clin North Am 1994 78 555-575. 

Kiefel V. Differential diagnosis of acute thrombocytopenia. In Warkentin TE, Greinacher A, eds. Heparin-induced Thrombocytopenia, 2nd ed. New York, Marcel Dekker, 2001 17-41. 

No Initial Therapy. Because there are no convincing data that standard treatment approaches have improved survival, some clinicians have adopted a watch and wait approach for asymptomatic patients in which therapy is delayed until the patient experiences systemic symptoms or disease progression such as rapidly progressive or bulky adenopathy, anemia, thrombocytopenia, or disease in threatening sites such as the orbit or spinal cord. The median time until treatment is required is 3 to 5 years, and about 20% of patients do not require therapy for up to 10 years. The 10-year survival is 73%, which is not significantly different from patients who received therapy at the time of diagnosis. In a randomized study of asymptomatic patients... 

A number of laboratory abnormalities can be identified at the time of diagnosis. As stated above, lymphocytosis in the peripheral blood and lymphocytic infiltration of the bone marrow are usually seen at diagnosis. Anemia, thrombocytopenia, and neutropenia are frequently evident, either at the time of diagnosis or some time during... 

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