Thrombocytopenia

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Updated by: Dr. Julie Panepinto and Dr. Paul Scott
Updated on: 5/9/2017

Definition

A condition in which the patient has a low blood platelet count. Normal platelet count is 150,000 to 400,000 throughout childhood.

Diagnosis/symptom

Signs and symptoms:

• Onset, Bleeding site, Severity
• Acute: petechiae, purpura, epistaxis, menorrhagia
• Chronic: easy bruising, epistaxis, prolonged and/or frequent menstrual bleeding

Causes

• 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.