{
"topic": "Thrombocytopenia",
"slug": "thrombocytopenia",
"category_id": 15500,
"passage_count": 14,
"source_chars": 11957,
"enough_material": true,
"references": [
{
"title": "Algorithms in Pediatrics",
"author": null,
"pages": [
295
]
},
{
"title": "Caring for the Hospitalized Child",
"author": "Section on Hospital Medicine, American Academy of Pediatrics;Jeffrey C. Gershel;Daniel A. Rauch;",
"pages": [
401
]
},
{
"title": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital)",
"author": null,
"pages": [
456
]
},
{
"title": "The Harriet Lane Handbook (The Johns Hopkins Hospital)",
"author": null,
"pages": [
456
]
},
{
"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
"author": null,
"pages": []
},
{
"title": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll)",
"author": "Lissauer, Tom,Carroll, Will",
"pages": [
432
]
},
{
"title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
"author": null,
"pages": [
1042
]
},
{
"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
"author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
"pages": [
960
]
}
],
"passages": [
{
"source": "Algorithms in Pediatrics, p. 295",
"text": "## **CONCLUSION** Thrombocytopenia is a common cause of bleeding in children. A knowledge of its causes, detailed history, and thorough clinical examination is necessary to narrow down the diagnostic possibilities. Relevant investigations need to be done to reach a correct diagnosis. **270** [Figure OCR, page 295, figure 1] Patient with thrombocytopenia History | Physical examination Complete blood count/peripheral smear/HIV (rule out spurious thrombocytopenia, malaria, AIDS) Associated Associated pancytopenia anemia Red cell fragments | Normal/spherocytes/macrocytes } Bone marrow J Direct Coombs ANA Autoimmune (SLE, ES, IM)"
},
{
"source": "Caring for the Hospitalized Child, p. 401",
"text": "Table 49\u20131. Differential Diagnosis of Thrombocytopenia in Children
Diagnosis Clinical Features
Pseudothrombocytopenia Falsely low platelet count, secondary to EDTA-induced clumping
Obtain blood sample in citrate or heparinized tube
Increased Platelet Destruction
Idiopathic thrombocytopenia Most common cause of thrombocytopenia
purpura Peak at 1\u20134 years of age
Occurs 1\u20134 weeks after an innocuous viral illness
Generalized petechiae and purpura
Normal white blood cells, hemoglobin, PT/PTT
Large platelets (MPV . 10 fL)
Drug-induced Occurs 1\u20132 weeks after starting new medication or acutely after a single dose
thrombocytopenia Recovery begins within 1\u20132 days of stopping drug
May be associated with sulfonamides, vancomycin, valproic acid, phenytoin,
carbamazepine, heparin
Systemic lupus Thrombocytopenia can be the initial manifestation
erythematosus Occurs in 20%\u201340% of patients
Can be associated with antiphospholipid antibody syndrome
Hemolytic uremic"
},
{
"source": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital), p. 456",
"text": "- **E. Management of Thrombocytopenia** 1. **ITP[17]** - a. Pathophysiology: Immune- mediated destruction of circulating platelets. - b. Presentation: Otherwise healthy 2- to 10- year- old child with sudden bruising or bleeding after recent mild illness or vaccination, isolated thrombocytopenia (platelets <100,000/\u03bcL), and peripheral smear with thrombocytopenia and reticulated large platelets. - c. Diagnostic testing: No additional testing needed if presentation consistent with ITP. If persists >3 to 6 months, pursue further workup: Infection testing (human immunodeficiency virus, hepatitis - C, _Helicobacter pylori_ infection), antinuclear antibody, anticardiolipin **346 Part II** Diagnostic and Therapeutic Information ## ~~**TABLE 14.9**~~ ## **APPROACH TO THROMBOCYTOPENIA ACQUIRED** "
},
{
"source": "The Harriet Lane Handbook (The Johns Hopkins Hospital), p. 456",
"text": "- **E. Management of Thrombocytopenia** 1. **ITP[17]** - a. Pathophysiology: Immune- mediated destruction of circulating platelets. - b. Presentation: Otherwise healthy 2- to 10- year- old child with sudden bruising or bleeding after recent mild illness or vaccination, isolated thrombocytopenia (platelets <100,000/\u03bcL), and peripheral smear with thrombocytopenia and reticulated large platelets. - c. Diagnostic testing: No additional testing needed if presentation consistent with ITP. If persists >3 to 6 months, pursue further workup: Infection testing (human immunodeficiency virus, hepatitis - C, _Helicobacter pylori_ infection), antinuclear antibody, anticardiolipin **346 Part II** Diagnostic and Therapeutic Information ## ~~**TABLE 14.9**~~ ## **APPROACH TO THROMBOCYTOPENIA ACQUIRED** "
},
{
"source": "Algorithms in Pediatrics, p. 295",
"text": "[Figure OCR, page 295, figure 2] Isolated thrombocytopenia Reassess physical findings \u00a5 \u00a5 v | rophecerey | Congenital Normal lymphadenopathy anomalies * BM, ANA, DCT, urine * BM examination | | * TAR syndrome + Fanconi's anemia + Radiology + WAS + Von Willebrand screen} | + HIV test * MVH9 syndrome + Thyroid function ITP, drug-induced tests + Type 2B VWD + Congenital thrombocytopenia + Hyperthyroidism * Leukemia, IM, hypersplenism, storage disorders + Osteoporosis, histiocytosis **CHAPTER 59:** Algorithmic Approach to Thrombocytopenia in Children ## ~~**KEY POINTS**~~ - ) Thrombocytopenia is defined as platelet count less than 150,000/cumm - ) Thrombocytopenia can have multiple etiologies: either due to decreased production, or increased destruction or due to splenic sequestration - ) Detailed history and thorough clinical examination and relevant investigations need to be done to reach a correct diagnosis"
},
{
"source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
"text": "OTHER DISORDERS ASSOCIATED WITH THROMBOCYTOPENIA Neonatal Thrombocytopenia Thrombocytopenia can arise in neonates from a number of different etiologies: immune mediated, perinatal asphyxia, inherited thrombocytopenias, drug/medication toxicity, and infection. Careful assessment of the clinical status of the neonate as well as the timing of the thrombocytopenia can help narrow the differential diagnosis. The two most common immune-mediated causes are neonatal alloimmune thrombocytopenia (NAIT) and autoimmune neonatal thrombocytopenia."
},
{
"source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 432",
"text": "Thrombocytopenia may result in bruising, petechiae, purpura and mucosal bleeding (e.g. epistaxis, bleeding from gums when brushing teeth). Major haemorrhage in the form of severe gastrointestinal haemorrhage, haematuria, and intracranial bleeding is much less common. The causes of easy bruising and purpura are listed in Table 23.5. While purpura may signify thrombocytopenia, it also occurs with a normal platelet count from platelet dysfunction and vascular disorders. ## _**Immune thrombocytopenia**_ ITP is the most common cause of thrombocytopenia in childhood. It has an incidence of around 4 per 100 000 children per year. It is usually caused by destruction of circulating platelets by antiplatelet IgG autoantibodies. The reduced platelet count may be accompanied by a compensatory increase of megakaryocytes in the bone marrow. ## **Clinical features** Most children present between the ages of 2 years and 10 years, with onset often 1 week to 2 weeks after a viral"
},
{
"source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 1042",
"text": "are between 1 and 6 cases per 100,000 children per year in the U.S. In this condition, thrombocytopenia results from an immune-mediated destruction of circulating platelets. It is usually acute in onset and self-limited, but it can become chronic or recurrent. ITP is a diagnosis of exclusion, so other causes must be ruled out. Acute ITP affects boys and girls equally and has a peak between 2 and 5 years of age. Chronic ITP more com- monly affects adolescents or adults. A history of recent (in the preceding 1-6 weeks) viral infection or immuniza- tion is found in a large percentage of those affected. Acute bruising, petechiae, or bleeding is usually the 1* sign. Petechiae and purpuric lesions occur spontaneously or with minor trauma. No hepatosplenomegaly is noted. In menstruating girls, a platelet count < 10,000/pL (< 10 x 10\u00b0/L) can result in severe blood loss. Intracranial hemorrhage occurs in < 1% of children with ITP and is fatal in 1/3 of these cases."
},
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 960",
"text": "**927** **HEMATOLOGIC DISORDERS** ## **ABNORMALITIES OF PLATELET** ~~**NUMBER OR FUNCTION**~~ Thrombocytopenia in the pediatric age range is often immune-mediated (eg, ITP, neonatal auto- or alloimmune thrombocytopenia), but is also caused by consumptive coagulopathy (eg, DIC, Kasabach-Merritt phenomenon), acute leukemias, or rarer disorders such as Wiskott-Aldrich syndrome and type 2b vWD, and artifactually in automated cytometers (eg, Bernard-Soulier syndrome), where giant forms may not be enumerated as platelets. ## **1. Idiopathic Thrombocytopenic Purpura** ## ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES - \u00bb Otherwise healthy child. - \u00bb Decreased platelet count. - \u00bb Petechiae, ecchymoses. ## \u00bb **General Considerations**"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 3075",
"text": "## **533.1** Immune Thrombocytopenia ## _Brian R. Branchford and Veronica H. Flood_ The most common cause of acute onset of thrombocytopenia in an otherwise- well child is immune thrombocytopenia **(ITP)** (also called immune or idiopathic thrombocytopenic purpura). ## **EPIDEMIOLOGY** In a small number of children, estimated at 1/20,000, 1- 4 weeks after exposure to a common viral infection, an autoantibody directed against the platelet surface develops with resultant sudden onset of thrombocytopenia. A recent history of viral illness is described in 50\u201365% of children with ITP. The peak age is 1- 4 years, although the age ranges from early in infancy to elderly. In childhood, males and females are equally affected. ITP seems to occur more often in late winter and spring after the peak season of viral respiratory illness. Approximately 5\u201310% of ITP may recur more than 3 months after initial disease resolution. ## **PATHOGENESIS**"
},
{
"source": "Algorithms in Pediatrics, p. 295",
"text": "- thrombocytopenia. ## **TREATMENT** Treatment involves management of the underlying cause. Platelet transfusions are often performed to tide over the crisis. Immune thrombocytopenic purpura is the most common cause of acute thrombocytopenia in a well child and the treatment involves observation, intravenous immunoglobulins, steroids, and others. In children without significant clinical bleeding, serial platelet counts will help decide the course of therapy to be adopted.  **----- Start of picture text -----**
ALgORITHM 1
Approach to thrombocytopenia
**----- End of picture text -----**
"
},
{
"source": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga), p. 357",
"text": "immune basis. This is the commonest bleeding disorder presenting in children between 1 and 7 years of age. It is important to correctly diagnose this entity and differentiate it from other ominous conditions. Thrombocytopenia lasting less than 6 months is termed acute, and greater than 6 months is termed chronic. The majority of children (60-75%) are likely to have acute ITP that resolves within 2-4 months of diagnosis, regardless of therapy. Pathogenesis Normal platelet counts vary between 150 and 400 x 10\u00b0/mm? in children above one week of age. ITP is believed to have an immune pathogenesis, against the platelet glycoprotein IIb/IIIa complex. Platelets with surface antibodies are trapped in the spleen, and removed by macrophages. The History and physical examination Platelet count a 4 Thrombocytopenia + Normal platelet count Prothrombin time (PT), activated partial thromboplastin time (aPTT) \u2018Thrombotic microangiopathy Malignancy Fanconl anemia Thrombocytopenia with absont radil Platelet dysfunction"
},
{
"source": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition, p. 1126",
"text": "**128:** thROmBOcytOpENIA AND pLAtELEt DySfuNctION 1093  **----- Start of picture text -----**
Neonatal thrombocytopenia Maternal causes: Preeclampsia
medications, lupus, ITP,
occult TORCH infection
Healthy normal newborn
Neonatal causes: HPA alloimmunity
is most common. Others:
hereditary, amegakaryocytic,
No
Wiskott-Aldrich
TAR, Fanconi, Turner, Kassabach-
Any congenital anomaly
Merritt syndromes, trisomies
No
Bacterial or fungal sepsis, birth
Acute neonatal illness asphyxia, NEC, others such as
RDS, PPHN
No
TORCH including HIV infection CMV, toxoplasmosis, herpes, HIV
No
IDM, dehydration, asphyxia, or
Thrombus indwelling central catheters.
Atrial, renal, vena cava, or
sinus venous thrombosis
No
Persistent thrombocytopenia >10 days, consult hematology
**----- End of picture text -----**
"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 3083",
"text": "## **533.9** Neonatal Thrombocytopenia ## _Brian R. Branchford and Veronica H. Flood_ Thrombocytopenia in the newborn rarely is indicative of a primary disorder of megakaryopoiesis. It is usually the result of systemic illness or transfer of maternal antibodies directed against fetal platelets (see Table 533.3). Neonatal thrombocytopenia often occurs in association with congenital viral infections, especially rubella, cytomegalovirus, protozoal infection (e.g., toxoplasmosis), and syphilis, and perinatal bacterial infections, especially those caused by gram- negative bacilli. Thrombocytopenia associated with DIC may be responsible for severe spontaneous bleeding. The constellation of marked thrombocytopenia and abnormal abdominal findings is common in necrotizing enterocolitis and other causes of necrotic bowel. Thrombocytopenia in an ill child requires a prompt search for viral and bacterial pathogens."
}
]
}