Consultation for Thrombocytopenia in Hospitalized Patients

Abstract 4659

Thrombocytopenia is a frequent cause for hematologic consultation in an acute care hospital. During a 22 month period one hematologist assessed 93 patients with thrombocytopenia. Thrombocytopenia was the sole reason for the consultation. No previous thrombocytopenia had been recognized previously in any if these patients.

The cause for thrombocytopenia was liver diease in 21 patients, sepsis in 12, immune (ITP) in 12, antimetabolites or antiseizure medications in 7, heparin induced thrombocytopenia (HIT) in 6, platelet clumping in 4, thrombotic thrombocytopenic purpura (TTP) in 3, myelodysplasia (MDS) in 3, acute progranulocytic leukemia (APL) in 3, rhabdomyolysis in 2, viral infections in 2, systemic lupus (SLE) in 2, and intravenous antibiotics in 2.

The following conditions were each diagnosed once as the cause for thrombocytopenia:pregnancy, disseminated intravascular coagulation (DIC), post coronary bypass grafting, brain injury, acute myelogenous leukemia (AML-M5), antiphospholipid syndrome (APLS), and intra aortic ballon pump.

No diagnosis could be made in 13 patients. In 28 patients the initial diagnosis was incorrect. No diagnosis could be made in 13 patients. In 6 patients two causes for thrombocytopenia were present. One patient was admitted twice with two different causes for thrombocytopenia (sepsis and ITP).

Review of the peripheral smear is both necessary and mandatory. All three patients with APL were initially diagnosed with ITP, and the diagnosis of APL was not made until the smear was assessed. Smear review confirmed or made the diagnosis of TTP. Platelet clumping could not be made without reviewing the peripheral smear.

Primary hematologic diagnoses (ITP, HIT, clumping, TTP, MDS, APL, AML, APLS) were present in 33 patients. Secondary causes for thrombocytopenia were present in the majority of patients.

In summary thrmobocytopenia a frequent cause for hematologic consultation, and most patients will not have a primary hematologic etiology for the thrombocytopenia. Advanced liver disease is an underappreciated cause for thrombocytopenia and was never considered to be the cause for the thrombocytopenia by the referring physician.

Despite exhaustive testing the cause for thrombocytopenia could not be made in 13 patients. However in these patients the platelet count rarely was below 100,000.

The importance of reviewing the peripheral smear cannot be overemphasized.