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Chapter 109. Disorders of Platelets and Vessel Wall (Part 3)

Approach to the Patient: Thrombocytopenia The history and physical examination, results of the CBC, and review of the peripheral blood smear are all critical components in the initial evaluation of the thrombocytopenic patients (Fig. 109-2). The overall health of the patient and whether he/she is receiving drug treatment will influence the differential diagnosis. A healthy young adult with thrombocytopenia will have a much more limited differential diagnosis than an ill hospitalized patient who is receiving multiple medications. Except in unusual inherited disorders, decreased platelet production usually results from bone marrow disorders that also affect red blood cell (RBC) and/or. | Chapter 109. Disorders of Platelets and Vessel Wall Part 3 Approach to the Patient Thrombocytopenia The history and physical examination results of the CBC and review of the peripheral blood smear are all critical components in the initial evaluation of the thrombocytopenic patients Fig. 109-2 . The overall health of the patient and whether he she is receiving drug treatment will influence the differential diagnosis. A healthy young adult with thrombocytopenia will have a much more limited differential diagnosis than an ill hospitalized patient who is receiving multiple medications. Except in unusual inherited disorders decreased platelet production usually results from bone marrow disorders that also affect red blood cell RBC and or white blood cell WBC production. Because myelodysplasia can present with isolated thrombocytopenia the bone marrow should be examined in patients presenting with isolated thrombocytopenia who are older than 60 years. While inherited thrombocytopenia is rare any prior platelet counts should be retrieved and a family history regarding thrombocytopenia obtained. A careful history of drug ingestion should be obtained including nonprescription and herbal remedies as drugs are the most common cause of thrombocytopenia. Figure 109-2 Algor ithm for Thrombocytopenia Evaluation Plalatgt count -- 150 000 111 Sower F uei AS. Ktfptr DL BMunwald E. St. Longe DL. Jimtiw JU LaictlEe J 17th Edition http wwwi ic e5iirricd cin l.cpnn Copyright Th McGriw-Hdt C mp nk i. Ene. All rightsr4rf4i irif. -1 1 J- - J 2- - Algorithm for evaluating the thrombocytopenic patient. The physical examination can document an enlarged spleen evidence of chronic liver disease and other underlying disorders. Mild to moderate splenomegaly may be difficult to appreciate in many individuals due to body habitus and or obesity but can be easily assess by abdominal ultrasound. A platelet count of approximately 5000-10 000 is required to maintain vascular integrity in the .