Differential diagnoses of thrombocytopenia
| Previously diagnosed or possible high risk for conditions that may be associated with immune thrombocytopenia (eg, infections [HIV, HCV, HBV]), autoimmune/immunodeficiency disorders (CVID, systemic lupus erythematosus, or APS), and malignancy (eg, lymphoproliferative disorders) |
| Liver disease (including cirrhosis or portal hypertension) |
| Splenomegaly |
| Drugs (prescription or nonprescription), including heparin, alemtuzumab, PD-1 inhibitors, abciximab, valproate, alcohol abuse, consumption of quinine (tonic water), exposure to environmental toxins, or chemotherapy |
| Bone marrow diseases, including myelodysplastic syndromes, leukemias, other malignancies, metastatic disease, myelofibrosis, aplastic anemia, megaloblastic anemia, myelophthisis, and Gaucher disease |
| Recent transfusions (rare possibility of posttransfusion purpura) and recent vaccinations |
| Inherited thrombocytopenia: TAR syndrome, radioulnar synostosis, congenital amegakaryocytic thrombocytopenia, Wiskott-Aldrich syndrome, MYH9-related disease, Bernard-Soulier syndrome, type IIB VWD, or platelet-type VWD |
| Other thrombocytopenic disorders (DIC, TTP, HUS, Evans syndrome) |
| Previously diagnosed or possible high risk for conditions that may be associated with immune thrombocytopenia (eg, infections [HIV, HCV, HBV]), autoimmune/immunodeficiency disorders (CVID, systemic lupus erythematosus, or APS), and malignancy (eg, lymphoproliferative disorders) |
| Liver disease (including cirrhosis or portal hypertension) |
| Splenomegaly |
| Drugs (prescription or nonprescription), including heparin, alemtuzumab, PD-1 inhibitors, abciximab, valproate, alcohol abuse, consumption of quinine (tonic water), exposure to environmental toxins, or chemotherapy |
| Bone marrow diseases, including myelodysplastic syndromes, leukemias, other malignancies, metastatic disease, myelofibrosis, aplastic anemia, megaloblastic anemia, myelophthisis, and Gaucher disease |
| Recent transfusions (rare possibility of posttransfusion purpura) and recent vaccinations |
| Inherited thrombocytopenia: TAR syndrome, radioulnar synostosis, congenital amegakaryocytic thrombocytopenia, Wiskott-Aldrich syndrome, MYH9-related disease, Bernard-Soulier syndrome, type IIB VWD, or platelet-type VWD |
| Other thrombocytopenic disorders (DIC, TTP, HUS, Evans syndrome) |
This table lists frequent examples of differential diagnoses of ITP and possible alternative causes of thrombocytopenia identified by patient history.
APS, antiphospholipid syndrome; CVID, common variable immunodeficiency; DIC, disseminated intravascular coagulation; HUS, hemolytic-uremic syndrome; MYH9, myosin heavy chain 9; PD-1, programmed cell death protein 1; TAR, thrombocytopenia-absent radius; TTP, thrombotic thrombocytopenic purpura; VWD, von Willebrand disease.