Thrombocytopenia: the good, the bad and the ugly

Abstract

New thrombocytopenia may be associated with a variety of conditions and diagnosis can be challenging. Presentation can vary from life-threatening bleeding or thrombosis to an incidental finding in an asymptomatic patient. New thrombocytopenia requires urgent investigation. Investigations are mainly guided by findings from the clinical history, physical examination, full blood count and blood film analysis. Aside from the actively bleeding patient, rare but life-threatening causes of thrombocytopenia must be identified early as they require urgent treatment. These include thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, suspicion of new acute promyelocytic leukaemia, and vaccine-induced prothrombotic immune thrombocytopenia. Here, we discuss how to approach a patient with new thrombocytopenia, along with key differentials not to be missed.

Keywords: bleeding; haematology; platelets; thrombocytopenia; thrombosis.

Fig 1.

Blood films. a) Red cell fragmentation obtained from a patient presenting with renal failure and confusion secondary to thrombotic thrombocytopenic purpura. b) Thrombocytopenia and features of disseminated intravascular coagulation obtained from a patient presenting with bleeding secondary to acute promyelocytic leukaemia.