Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jul 13;7(3):157-167.
doi: 10.1080/20009666.2017.1335156. eCollection 2017 Jul.

New-onset acute thrombocytopenia in hospitalized patients: pathophysiology and diagnostic approach

Naveed Ali  1 , Herbert E Auerbach  2
Affiliations
Review

New-onset acute thrombocytopenia in hospitalized patients: pathophysiology and diagnostic approach

Naveed Ali et al. J Community Hosp Intern Med Perspect. .

Abstract

Thrombocytopenia is a hematological finding commonly encountered in daily clinical practice from asymptomatic clinic patients to critically ill intensive care unit patients. A broad spectrum of etiologies and variation in clinical presentation often present a diagnostic challenge. Furthermore, concomitant presence of thrombosis and thrombocytopenia, as in cases of thrombotic thrombocytopenia, complicates the management. In hospitalized patients, new-onset thrombocytopenia is an important reason for hematology consultation. Therefore, it is of utmost importance that the etiology is diagnosed accurately. In addition, a basic understanding of the pathophysiology and the differential diagnosis avoids delay in the diagnosis and leads to rapid initiation of treatment. This review will address causes of thrombocytopenia that arises in hospitalized patients with an emphasis on the pathophysiological basis of each disorder.

Keywords: Thrombocytopenia; hospital acquired; pathophysiology; thrombopoiesis; thrombopoietin.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Thrombopoiesis begins in the bone marrow milieu with the differentiation of pleuripotent stem cell to megakaryocytes. Several key regulators (TPO, interleukins, B12, folate, NF-κB) are involved in platelet formation. Platelets have several destinations in the peripheral circulation including self-regulated apoptosis, consumption in response to injury, splenic sequestration, and platelet destruction. Causes of decreased platelet production (yellow box) and increased peripheral destruction (red box) are shown. Abbreviations: MDS (myelodysplastic syndrome), TPO (thrombopoietin), IL (interleukin), SCF (stem cell factor), NF-κB (nuclear factor kappa B), DIC (disseminated intravascular coagulation), HELLP (hemolysis, elevated liver enzymes and low platelets).
Figure 2.
Figure 2.
An algorithmic approach to hospital-induced thrombocytopenia. Abbreviations: DIC (disseminated intravascular coagulation), TTP (thrombotic thrombocytopenic purpura), ST-HUS (Shiga toxin-mediated hemolytic uremic syndrome), aHUS (atypical hemolytic uremic syndrome), CPB (cardiopulmonary bypass), IABP (intraaortic balloon pump), HIT (heparin-induced thrombocytopenia), DITP (drug-induced immune thrombocytopenia), HELLP ((hemolysis, elevated liver enzymes, and low platelets), PTP (post transfusion purpura).
Figure 3.
Figure 3.
Peripheral smear examination demonstrating, (a) small scattered platelet clumps; (b) platelet satellitism where platelets are arranged in a rosette-like pattern around the neutrophils; (c) schistocytes, bite cells, and scarcity of platelets, (d) a giant platelet almost the size of a red blood cell.
See this image and copyright information in PMC

References

    1. Buckley MF, James JW, Brown DE, et al. A novel approach to the assessment of variations in the human platelet count. Thromb Haemost. 2000;83(3):480–484. - PubMed
    1. Maes M, Scharpé S, Cooreman W, et al. Components of biological, including seasonal, variation in hematological measurements and plasma fibrinogen concentrations in normal humans. Experientia. 1995;51(2):141–149. - PubMed
    1. McMahon CM, Cuker A.. Hospital-acquired thrombocytopenia. Hosp Pract. 2014;42(4):142–152. - PubMed
    1. Akca S, Haji-Michael P, de Mendonça A, et al. Time course of platelet counts in critically ill patients. Crit Care Med. 2002;30(4):753–756. - PubMed
    1. Crowther MA, Cook DJ, Meade MO, et al. Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care. 2005;20(4):348–353. - PubMed