Differential Diagnosis of Thrombocytopenia According to Clinical Context

According to clinical context:

  • Outpatient:
    • Isolated thrombocytopenia:
      • Pseudothrombocytopenia
      • Immune thrombocytopenia
        • Primary – no underlying causative condition
        • Secondary – associated with:
          • Other autoimmune disorders
          • Immunodeficiency syndrome
          • Infections such as HIV and HCV
          • Recent vaccinations
          • Certain medications, including quinine
          • Chronic lymphocytic leukemia 
          • Posttransplant autoimmune lymphoproliferative syndrome 
      • Alcohol abuse
      • Cirrhosis
      • Antiphospholipid syndrome
      • Congenital (familial) thrombocytopenia
    • Thrombocytopenia associated with other changes on the complete blood count:
      • Non-malignant:
        • Cirrhosis
        • Post chemotherapy
      • Malignant:
        • Myelodysplasia (MDS)
        • Myeloproliferative neoplasms (MPNs)
        • MDS/MPN overlap syndrome
        • Chronic lymphocytic leukemia
        • Plasma cell dyscrasia
  • Obstetrical outpatient:
    • Gestational thrombocytopenia
    • Immune thrombocytopenia
    • Antiphospholipid syndrome
  • Emergency department:
    • Alcohol toxicity
    • Immune thrombocytopenia (ITP) with bleeding
    • TTP
    • HUS
    • DIC
    • Venous thromboembolism (VTE) with large clot burden
    • Dilutional thrombocytopenia from massive transfusion
  • Inpatient (new onset):
    • Medical:
      • Medications, especially heparin
      • Infection with or without DIC
      • Hemophagocytic lymphohistiocytosis (HLH)
    • Surgical:
      • Postoperative thrombocytopenia, especially in orthopedic surgery
      • VTE with large clot burden
      • Medications, especially heparin
      • Infection with or without DIC
    • Intensive care unit (ICU):
      • Medications, especially heparin
      • Infection with or without DIC
      • Extracorporeal circuits
      • HLH
      • Dilutional thrombocytopenia from massive transfusion
    • Coronary care unit (CCU):
      • Medications including
        • Antiplatelet agents
        • Heparin
      • Extracorporeal circuits
    • Obstetrics:
      • Antiphospholipid syndrome
      • HELLP
      • HUS
      • TTP
      • Eclampsia
      • Dilutional from treatment of postpartum hemorrhage

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