Evaluation of thrombocytopenia

Last reviewed: 7 Apr 2025
Last updated: 25 Jun 2024

Summary

Differentials

Common

  • Leukemia
  • Metastatic malignancy
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma
  • Miliary tuberculosis
  • Disseminated intravascular coagulation (DIC)
  • Post-transfusion
  • Hemolysis, elevated liver enzymes, low platelet count (HELLP)
  • Cardiopulmonary bypass
  • Immune thrombocytopenia (ITP)
  • Systemic lupus erythematosus (SLE)
  • Rheumatoid arthritis
  • Antiphospholipid syndrome
  • HIV/AIDS
  • Malaria
  • Dengue fever
  • Zika virus infection
  • Cytomegalovirus (CMV)
  • Infectious mononucleosis
  • COVID-19
  • Parvovirus B19
  • Sepsis
  • Heparin-induced thrombocytopenia (HIT)
  • Antimalarials, antiseizure drugs, antibiotics, or chemotherapies
  • Alcohol ingestion
  • B12 deficiency
  • Folate deficiency
  • Gestational thrombocytopenia
  • Cirrhosis
Full details

Uncommon

  • Multiple myeloma
  • Bone marrow fibrosis
  • Thrombotic thrombocytopenic purpura (TTP)
  • Hemolytic uremic syndrome (HUS)
  • Sarcoidosis
  • Cyclic thrombocytopenia
  • Wiskott-Aldrich syndrome
  • MYH9-related disorders, including May-Hegglin anomaly
  • Bernard-Soulier syndrome
  • Gaucher disease
  • Hashimoto thyroiditis
  • Aplastic anemia
  • Vaccinations
  • Paroxysmal nocturnal hemoglobinuria (PNH)
  • Pseudothrombocytopenia
  • Familial platelet disorder with germline RUNX1 mutation
  • Thrombocytopenia due to germline ANKRD26 mutation
  • Thrombocytopenia due to germline ETV6 mutation
Full details

Contributors

Authors

Julia T. Geyer, MD

Associate Professor

Weill Cornell Medicine

Pathology and Laboratory Medicine

Division of Immunopathology

New York

NY

Disclosures

JTG declares that she has no competing interests.

Acknowledgements

Dr Julia T. Geyer would like to gratefully acknowledge Dr Alan E. Lichtin, a previous contributor to this topic.

Disclosures

AEL is on an advisory board and has received research support from Amgen.

Peer reviewers

Roger M. Lyons, MD, FACP

Clinical Professor of Medicine

University of Texas Health Science Center

San Antonio

Cancer Care Network of South Texas

San Antonio

TX

Disclosures

RML declares that he has no competing interests.

Jeffrey S. Wasser, MD

Clinical Assistant Professor of Medicine

University of Connecticut School of Medicine

Farmington

CT

Disclosures

JSW has received research support from Amgen, Ligand Pharmaceuticals, and MGI Pharma for clinical studies in immune thrombocytopenic purpura.

Keith R. McCrae, MD

Professor of Medicine

Case Western Reserve University School of Medicine

Cleveland

OH

Disclosures

KRM declares that he has no competing interests.

References

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Key articles

Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019 Nov 26;3(22):3780-817.Full text  Abstract

Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood. 2017 Nov 23;130(21):2271-7.Full text  Abstract

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 207: thrombocytopenia in pregnancy. Obstet Gynecol. 2019 Mar (reaffirmed 2022);133(3):e181-93. Abstract

Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019 Sep 5;381(10):945-55.Full text  Abstract

Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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