Physical exam and history e/o thrombocytopenia may include: petechiae, purpura, oral petechiae, ecchymoses, lymphadenopathy, hypersplenism, bloody diarrhea, fever, s/sx of blood clots if hypercoaguable as in HIT.
Assessment & Plan (short)
New thrombocytopenia likely due to ***. Common mechanisms include destruction (TTP, HUS, DIC, HIT, ITP), decreased production (leukemia, myelodysplastic, viral, drugs, ETOH, Vit B12, folate, copper deficiencies), and sequestration/hypersplenism (cirrhosis, heart failure, malignancy, infections). Also considered is pseudothrombocytopenia from clumping, smear can exclude.
- CBC w/diff
- HIV, HCV
- HIT Ab with reflex SRA if c/f HIT, stop all heparin products
- Smear, coags, fibrinogen, LDH, retics (if c/f BM suppression)
- Retics, immature platelet fraction (if c/f production problem)
- Platelet goal > *** (often 10 unless active bleeding then 50, 100 if c/f CNS bleed)
- Patient consented for blood products
- Hold DVT prophylaxis for plts < *** (typically 50), otherwise continue as appropriate