Version May 2024
| Falsely low platelet counts (pseudothrombocytopenia) |
| In vitro platelet clumping caused by ethylenediaminetetraacetic acid (EDTA)-dependent agglutinins (naturally occurring antibodies) |
| In vitro platelet clumping caused by an insufficiently anticoagulated specimen |
| In vitro platelet clumping caused by glycoprotein IIb/IIIa inhibitors (eg, abciximab) (NOTE: these can also cause true thrombocytopenia) |
| Giant platelets counted by automated counter as white blood cells rather than platelets |
| Common causes of thrombocytopenia |
| Primary immune thrombocytopenia (ITP) |
| Drug-induced immune thrombocytopenia (DITP) |
| Heparin (NOTE: special case, also can cause thrombosis) |
| Quinine (as in over-the-counter tablets for leg cramps; also in beverages) |
| Sulfonamides (eg, trimethoprim-sulfamethoxazole [Bactrim; Septra]) |
| Acetaminophen (Tylenol, Panadol) |
| Cimetidine (Tagamet) |
| Ibuprofen (Advil, Motrin) |
| Naproxen (Aleve, Midol) |
| Ampicillin (Omnipen, Apo-Ampi) |
| Piperacillin (Pipracil, Zosyn) |
| Vancomycin (Vancocin) |
| Glycoprotein IIb/IIIa inhibitors (abciximab [ReoPro], tirofiban [Aggrastat], eptifibatide [Integrilin]) |
| Food and beverages |
| Quinine-containing beverages (tonic water, Schweppes bitter lemon) |
| Walnuts |
| Certain herbal teas |
| Infections |
| HIV |
| Hepatitis C |
| Epstein-Barr virus (EBV; can be associated with infectious mononucleosis) |
| Helicobacter pylori (suspected in patients with symptoms of dyspepsia or peptic ulcer disease) |
| Sepsis with disseminated intravascular coagulation (DIC) |
| Intracellular parasites (eg, malaria, babesia) |
| Hypersplenism due to chronic liver disease |
| Alcohol |
| Nutrient deficiencies (eg, vitamin B12, folate, copper) |
| Rheumatologic/autoimmune disorders (eg, systemic lupus erythematosus, rheumatoid arthritis) |
| Pregnancy |
| Gestational thrombocytopenia |
| Preeclampsia |
| HELLP syndrome (hemolysis, elevated liver function tests, low platelets) |
| Other causes of thrombocytopenia |
| Myelodysplasia |
| Suspected in older patients, in whom a bone marrow biopsy may be appropriate |
| Cancer with disseminated intravascular coagulation |
| Cancer with bone marrow infiltration or suppression (eg, lymphoma, leukemia, some solid tumors) |
| Paroxysmal nocturnal hemoglobinuria (PNH) |
| Thrombotic microangiopathy (TMA) |
| Thrombotic thrombocytopenic purpura (TTP) is manifested by thrombocytopenia and microangiopathic hemolytic anemia; fever, renal failure, and/or neurologic symptoms may or may not be present |
| Hemolytic uremic syndrome (HUS) is typically seen in children following infection with a Shiga-toxin producing organism (Escherichia coli or Shigella) |
| Drug-induced TMA may occur with quinine, certain cancer therapies, calcineurin inhibitors, and others |
| Antiphospholipid syndrome (APS) |
| Aplastic anemia |
| Hereditary thrombocytopenias |
| An important consideration, especially in young patients who do not respond to treatment. Some specific syndromes are listed. However, many patients appear to have autosomal dominant thrombocytopenia with no other clinical features. |
| Von Willebrand disease type 2B |
| Wiskott-Aldrich syndrome |
| Alport syndrome |
| May-Hegglin anomaly |
| Fanconi anemia |
| Bernard-Soulier syndrome |
| Thrombocytopenia absent radius syndrome |
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