Differential Diagnosis of Thrombocytopenia According to Mechanism

According to the mechanism of thrombocytopenia

  • Decreased production:
    • Isolated thrombocytopenia (rare):
      • Alcohol toxicity (suppression of platelet production)(suppression of platelet production)
      • Amegakaryocytic thrombocytopenia
      • Medications, including:
        • Linezolid (suppression of platelet production)
        • Bortezomib (inhibition of proplatelet formation of megakaryocytes)
        • Thiazide diuretics (selective suppression of megakaryocyte production, may also cause immune-mediated destruction of platelets)
        • Chlorothiazide
      • Infections such as HIV and HCV (may also cause immune-mediated destruction of platelets)
      • Congenital thrombocytopenia
    • Thrombocytopenia associated with changes in other hematopoietic cell lines, for example with/in:
      • Infiltrative disorders of bone marrow
      • Aplastic anemia
      • Megaloblastic anemia
      • Chemotherapy
  • Increased consumption/destruction:
    • Consumption:
      • Thrombotic microangiopathy including:
        • Thrombotic thrombocytopenic purpura (TTP)
        • Atypical hemolytic uremic syndrome (aHUS)
        • Disseminate intravascular hemolysis (DIC)
      • Extracorporeal devices
      • Antiphospholipid syndrome
    • Antibody-mediated destruction
      • Immune thrombocytopenia
      • Antiphospholipid syndrome
      • Medications
    • Infection – for example babesiosis and anaplasmosis
  • Sequestration – hypersplenism, especially in setting of cirrhosis.

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