In today’s morning report, Dr. Gold presented a case of gum bleeding and fatigue in a young patient who was ultimately found to have severe thrombocytopenia secondary to ITP.

Some pearls:

• There are lots of reasons to have low platelets, but as you build your differential, remember the broad categories:
  • decreased production (i.e primary bone marrow failure, infections, toxins, infiltrative disease)
  • increased destruction (i.e. ITP, HIT, TTP/HUS, DIC)
  • sequestration (splenomegaly)
• When approaching a patient with unexplained thrombocytopenia, its important to 1) confirm that its real (repeat the CBC), 2) compare the platelet count to prior labs, and 3) look for other hematologic abnormalities which may indicate a more systemic process.
• A peripheral smear, coags and hemolysis labs will help guide the differential
• ITP is a diagnosis of exclusion, treatment involves transfusion, steroids, and IVIG depending on presentation, usually decided on in consultation with a hematologist.