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How I approach new onset thrombocytopenia.

Authors
  • Swain, Fiona1, 2, 3
  • Bird, Robert1, 2
  • 1 Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia. , (Australia)
  • 2 School of Medicine, University of Queensland, Brisbane, Australia. , (Australia)
  • 3 School of Medicine, Griffith University, Brisbane, Australia. , (Australia)
Type
Published Article
Journal
Platelets
Publisher
Informa UK (Taylor & Francis)
Publication Date
Jan 01, 2020
Volume
31
Issue
3
Pages
285–290
Identifiers
DOI: 10.1080/09537104.2019.1637835
PMID: 31269407
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Thrombocytopenia is a common reason for referral to hematologists in community and hospital practice. A broad differential diagnosis, combined with the potentially life-threatening nature of some presentations necessitates a rapid evaluation of the situation and potential need for emergency intervention; followed by further comprehensive investigation to confirm the diagnosis and institution of longer term management. This review offers an approach to the initial assessment, diagnosis, and referral. We then highlight aspects of the clinical history, examination and laboratory investigations which may provide critical insights into the most likely diagnosis. ITP is the commonest cause of severe isolated thrombocytopenia in the general community and is the most common cause of thrombocytopenia in patients referred to our hematology service. It remains a diagnosis of exclusion and a high degree of vigilance for alternative diagnoses should be maintained, particularly if presentations are atypical or expected response to treatment is not seen. Adult presentation of hereditary thrombocytopenia syndromes can mimic new onset thrombocytopenia, however, improving access to genetic testing will facilitate accurate diagnosis and avoid unnecessary treatment.

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