In this section
Updated by: Dr. Julie Panepinto and Dr. Paul Scott
Updated on: 5/9/2017
A condition in which the patient has a low blood platelet count. Normal platelet count is 150,000 to 400,000 throughout childhood.
Signs and symptoms:
- Onset, Bleeding site, Severity
- Acute: petechiae, purpura, epistaxis, menorrhagia
- Chronic: easy bruising, epistaxis, prolonged and/or frequent menstrual bleeding
- ITP, most common cause of acute thrombocytopenia children in otherwise well child
- Consumptive coagulopathy (DIC, HUS, TTP) in moderate to severely ill chill children
- Chronic thrombocytopenic syndromes, likely genetic and etiology in a well-child with chronic thrombocytopenia
Referring provider’s initial evaluation and management:
Diagnosis and Treatment (diagnosis is dependent):
- For acute ITP: observation, acute steroid burst, IVIG
- For chronic states: episodic platelet transfusion, immune suppressive medications such as rituxan, splenectomy depending on reason for thrombocytopenia, thrombopoietin-receptor mimetics
Initial evaluation and therapy:
- History and physical exam
- CBC, differential, Coagulation studies
When to initiate referral/ consider refer to Hematology Clinic:
- Sudden onset of moderate- severe thrombocytopenia (<20,000 platelets)
- Chronic thrombocytopenia of unknown cause
- Thrombocytopenic patient with uncontrolled bleeding
- Thrombocytopenic patient to undergo surgical intervention
What can referring provider send to Hematology Clinic?
1. Using Epic
- Please complete the external referral order In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:
- Urgency of the referral
- What is the key question you would like answered?
Note: Our office will call to schedule the appointment with the patient.
2. Not using Epic external referral order:
- In order to help triage our patients maximize the visit time, please fax the above information to (414-607-5288)
- It would also be helpful to include:
- Chief complaint, onset, frequency
- Recent progress notes
- Labs and imaging results
- Other Diagnoses
- Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient’s problems.
Specialist’s workup will likely include:
- CBC, differential, and reticulocyte count and smear
- Consideration of coagulation studies
- Genetic analysis for chronic thrombocytopenia syndromes
- More than one cell line is involved, consideration of bone marrow aspiration biopsy
- ANA, HIV studies for new onset ITP in an adolescent After referral to Hematology Clinic:
- For acute ITP: CBC to be followed at local clinic with phone contacts between primary physician’s office and pediatric hematology
- For chronic thrombocytopenic syndromes: observation with eventual genetic testing to be performed if thrombocytopenia persists for greater than one year and there is no preexisting history of a normal platelet count.