History

A 34 year-old man is referred to you for evaluation of new onset thrombocytopenia. He presented to his PCP the week prior for his annual physical. A routine complete blood count (CBC) showed a platelet count of 24 x 109/L. He has never had low blood cell counts in the past. He did not have symptoms of easy bruising or bleeding when he saw his PCP a week ago, but he states that his gums have recently started to bleed when he brushes his teeth and he now has “little red spots” on his lower legs. He has a history of hypertension. Otherwise he is well. He has never been hospitalized. He has never smoked and he drinks socially. He works as a property manager. He is taking lisinopril for his high blood pressure, but is on no other medication and has no known allergies.

In an outpatient with new onset thrombocytopenia, which of the following question(s) is/are important when taking a history:

a
Do you have any symptoms or recent infection?
Infections, especially H. pylori and viral infections, are associated with immune thrombocytopenia (ITP). Microbial antigens may mimic platelet autoantigens, thus triggering autoantibody-secreting plasma cells.
b
What medications are you taking, including over-the-counter preparations and herbal remedies?
Certain medications are associated with development of immune thrombocytopenia (ITP), including quinine or quinidine, antibiotics (e.g., penicillin, cephalosporin, sulfonamides and vancomycin), antirheumatic agents (gold and D-penicillamine), antiepileptics (phenytoin and valproic aid), and thiazide-type diuretics.
c
Do you drink alcohol in excess?
Alcohol may cause thrombocytopenia, though not typically to this low level.
d
Is there a family history of thrombocytopenia?
It is important to distinguish between immune thrombocytopenia and familial (congenital) thrombocytopenia.
e
Do you have a thyroid problem?
Thyroid disease is not related to immune thrombocytopenia (ITP)

These questions were specifically asked of our patient and the responses were negative.

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