Thrombocytopenia

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Thrombocytopenia is defined as a platelet count below 140 (normal lab ref range 140 – 400).

Individuals with platelet count of >50 are generally asymptomatic. The risk of spontaneous / significant bleeding increases when platelet count falls below 20X109/L.

Bleeding associated with thrombocytopenia is usually muco-cutaneous; bruising / petechiae, GI or GU bleeding. The risk of intra-cranial bleeding is relatively low except in the presence of another risk factor (A/V malformation, uncontrolled hypertension, anticoagulation therapy)

Potential causes

  • Chronic liver disease / Cirrhosis, Portal Hypertension
  • Alcohol, drugs (Quinine, Bendroflumethazide, Sulpha drugs, NSAIDs, Phenytoin, Methotrexate, H2 Blockers, Heparin)
  • Acute Sepsis
  • HIV, hepatitis C, hepatitis B
  • Immune Thrombocytopenia – isolated or associated with haemolytic anaemia
  • Bone Marrow Failure
  • Consumptive Coagulopathy (DIC, TTP, HUS)
  • Spurious thrombocytopenia (clotted sample, incomplete EDTA anticoagulation)

 

Assessment

  • History and examination for signs of an underlying systemic disorder, drug & alcohol
  • Repeat FBC, lab will add on blood film examination if appropriate
  • Liver and renal function test
  • Haematinics
  • Viral Serology -  HIV, Hepatitis C, Hepatitis B
  • Consider auto-immune screen – guided by history findings

Primary care management

  • Repeat FBC in 4 weeks in case of mild thrombocytopenia particularly if a potential cause has been identified and discontinued / reversed

Who to refer

Urgent referral to haematology

  • Isolated platelet count of <50
  • Platelet count of 50 – 100 with:
  • Concomitant cytopenia (Haemoglobin <100, Neutrophils <1.0), abnormal film
  • Splenomegaly, Lymphadenopathy
  • Patient due for planned surgery
  • In pregnancy

Patients presenting with platelet count <20 or excess bruising / bleeding – regardless of the platelet count – should be discussed with the on-call haematologist

Routine referral or advice request

  • Moderate persistent thrombocytopenia (platelet count 50 – 100 in at least 2 consecutive blood count) in the absence of a clear cause
  • Thrombocytopenia and history of thrombosis

Who not to refer

Cases with isolated stable mild thrombocytopenia ( platelet count of 100 – 140) do not need to be referred. Please discuss these cases with haematology team via advice request.

Editorial Information

Last reviewed: 01/10/2024

Next review date: 01/10/2026

Author(s): Muayed Lasebai, Ranjit Thomas, Paul Ames.

Version: 1.0