Analysis of Causes and Outcome of Thrombocytopenia as a Presenting Symptom in a Single Institution.

Patients suffering from thrombocytopenia admitted to the emergency room during nights and weekends might be a problem, depending from the availability of a haematologist on duty. We evaluated retrospectively the medical history of all patients entering our department receiving a bone marrow biopsy due to severe thrombocytopenia in the years from 2000–2003. We analyzed 441 patients admitted due to thrombocytopenia. 146 patients had a platelet count < 50,000/μl. 69 of these patients suffered from severe thrombocytopenia < 20,000/μl.

All patients entering the ER during daytime received a bone marrow biopsy during the first three hours post admission. If patients were admitted during the night, they received a biopsy the following morning. Bone marrow smears were stained according to Pappenheim and evaluated as soon as they were dry. Diagnoses were as the following: acute leukaemia 54; immune thrombocytopenia 31; aplastic anaemia/toxic bone marrow failure/myelodysplastic syndrome 36; Non Hodgkin’s Lymphoma 7; carcinosis of bone marrow 8; myeloproliferative syndrome 3; viral infection (Hanta, HIV) 2; sepsis 1; hypersplenism 2; thrombotic thrombocytopenic purpura 1; heparin induced thrombocytopenia type II 1.

During their time in the hospital only one patient of the 146 patients developed severe bleeding with the need of transfusion of blood packs. The 73 y old male patient with primary diagnosis of rectal carcinoma and 23,000 platelets at admission was diagnosed with secondary acute myeloid leukaemia. He showed lower gastrointestinal bleeding since rectal carcinoma could not be treated by surgery due to the leukaemia.

In summary 1 out of 146 patients with severe thrombocytopenia showed clinical bleedings (<1%), indicating this as a very rare event. Due to the fact that only 31 out of 146 patients (or 20 of 69 patients with platelets < 20,000/μl) with severe thrombocytopenia suffered from immune mediated thrombocytopenia immediate consultation of the haematologist is essential to allow rapid diagnosis and adequate treatment strategies in patients presenting with thrombocytopenia in the emergency department.