Clinical and Aetiological Profile of Thrombocytopenia in Adults: A Cross-sectional Study

Guidelines for the use of platelet transfusions.

Drug (vaccine)-induced thrombocytopenia 2021: Diversity of pathogenesis and clinical features.

Superiority of Avatrombopag to Placebo in Increasing Platelet Counts in Patients with Chronic Liver Disease-Associated Thrombocytopenia Undergoing Scheduled Procedures: Results from 2, Phase 3 Randomized Studies

After completing this article, readers should be able to: 1. List the platelet counts that represent mild, moderate, and severe thrombocytopenia. 2. List common causes of thrombocytopenia in sick neonates, preterm infants, and infants who have other medical conditions. 3. List the conditions characterized by physical abnormalities or dysmorphic features that commonly are associated with thrombocytopenia. 4. List potential causes of thrombocytopenia in healthy-appearing neonates. 5. Describe the clinical manifestations of and treatment for neonatal alloimmune thrombocytopenia. Platelet counts in healthy fetuses (mid-second trimester) and neonates are the same as in normal children and adults. Neonatal platelet counts of 100 to 150 × 10 3/mcL (100 to 150 × 10 9/L) represent mild thrombocytopenia, platelet counts of 50 to 100 × 10 3/mcL (50 to 100 × 10 9/L) are considered moderate thrombocytopenia, and levels less than 50 × 10 3/mcL (50 × 10 9/L) are categorized as severe thrombocytopenia. Thrombocytopenia in newborns is a result of increased platelet consumption (infections, thrombosis, immune-mediated) or decreased platelet production. In many neonates, particularly sick preterm infants, both impaired megakaryopoiesis and accelerated platelet destruction may occur simultaneously. Mild asymptomatic thrombocytopenia occurs in 1% of healthy term infants. Severe thrombocytopenia in term infants, however, is rare, and most affected infants usually are recognized because of hemorrhagic manifestations (petechiae, purpura, or frank bleeding). Any term neonate whose platelet count is less than 50 × 10 3/mcL (50 × 10 9/L) should be evaluated to establish a cause. In contrast to the rarity of thrombocytopenia in healthy term neonates, low platelet counts are noted commonly in sick infants who often are preterm. Up to 25% of infants admitted to the neonatal intensive care unit (NCIU) have thrombocytopenia. Also, in contrast to term newborns who present with hemorrhagic manifestations, most cases of thrombocytopenia in …

Recurrent severe thrombocytopenia in critical illness complicated by hemolysis.

Incidence and Outcome of Severe Thrombocytopenia Associated with Zika Virus Infection - Puerto Rico, 2016

Objective: Dengue has been emerging as rapidly spreading and dreaded mosquito-borne disease caused by the bite of Aedes Aegypti Mosquito. Clinical features are variable and presents with Dengue fever or Dengue Hemorrhagic fever or more severe Dengue shock syndrome. Thrombocytopenia is presenting feature in all Dengue cases and some often presents with bleeding. Platelet transfusions are given in patients with haemorrhagic symptoms. While medical fraternity globally recognizes the role of platelet transfusion in the management of hospitalized dengue patients the exact indications and situations in which these are to be transfused may vary. Since there is inherent risk associated with the transfusion of blood/blood-component, it is imperative for each institution (or country) to lay their own criteria for transfusion of these blood components. The present study was conducted to lay precise criteria and transfusion trigger for platelet transfusion in our setup.
 Methods: The present study was conducted on 225 serologically confirmed dengue patients admitted at sawaimansign Hospitals between 1" of August to 30th of November 2022. Clinical data, reports of hematological investigation, platelets requirements and data obtained from SHealth services.
 Results: In the serologically confirmed cases, the prevalence of thrombocytopenia (count less than 100,000/cumm) was 84.88% on admission and bleeding was recorded in 22 (9.7%) patients. About 96 (42.6%) patients of dengue cases received platelet transfusion. Among them 47 (20.88%) patients had a platelet count<20,000/cumm, 43 (19.11%) had a platelet count in the range of 21-40.000/cumm, while 6 (2.66%) patients had the platelet count in between 41 and 50.000/cumm. Out of 49 patients with a platelet count>20,000/cumm, 18 patients had hemorrhagic manifestations such as petechiae, gum-bleeding, epistaxis, etc., which necessitates the use of platelet transfusion. However, 31 patients received inappropriate platelet transfusion.
 Conclusion: This study suggests that bleeding occurs more often in patients with severe thrombocytopenia. High-risk patients having platelet count<20,000/cumm and risk of bleeding require urgent platelet transfusion. Patients with a platelet count 21-40,000/cumm are in moderate risk and require platelet transfusion only if they have any haemorrhagic manifestations and other superadded conditions.

Background and Objective:While medical fraternity globally recognizes the role of platelet transfusion in the management of hospitalized dengue patients the exact indications and situations in which these are to be transfused may vary. Since there is inherent risk associated with the transfusion of blood/blood-component, it is imperative for each institution (or country) to lay their own criteria for transfusion of these blood components. The present study was conducted to lay precise criteria and transfusion trigger for platelet transfusion in our set-up.Materials and Methods:The present study was conducted on 225 serologically confirmed dengue patients admitted at Indraprastha Apollo Hospitals between 1st of August to 30th of November 2005. Clinical data, reports of hematological investigation, platelets requirements and data obtained from daily follow-up were analyzed. The clinicians followed the guidelines issued by the Directorate of Health services, NCT of Delhi.Results:In the serologically confirmed cases, the prevalence of thrombocytopenia (count less than 100,000/cumm) was 84.88% on admission and bleeding was recorded in 22 (9.7%) patients. About 96 (42.6%) patients of dengue cases received platelet transfusion. Among them 47 (20.88%) patients had a platelet count < 20,000/cumm, 43 (19.11%) had a platelet count in the range of 21-40,000/cumm while 6 (2.66%) patients had the platelet count in between 41 and 50,000/cumm. Out of 49 patients with a platelet count >20,000/cumm, 18 patients had haemorrhagic manifestations such as petechiae, gum-bleeding, epistaxis, etc., which necessitates the use of platelet transfusion. However, 31 patients received inappropriate platelet transfusion.Conclusion:This study suggests that bleeding occurs more often in patients with severe thrombocytopenia. High-risk patients having platelet count < 20,000/cumm and risk of bleeding require urgent platelet transfusion. Patients with platelet count 21-40,000/cumm are in moderate risk and require platelet transfusion only if they have any haemorrhagic manifestations and other superadded conditions.

Background and Objective: Dengue fever is a prevalent cause of febrile illness, often associated with thrombocytopenia and bleeding manifestations. The study aims to investigate the relationship between platelet counts and bleeding manifestations among dengue patients admitted to a tertiary care hospital. Material &amp; Methods: A Cross-sectional study was conducted at the Department of Medicine, Nishtar Hospital, Multan, involving 140 confirmed dengue cases with platelet counts below 150,000/µL. This study was conducted over a period of 15 months from July 2023 to September 2024. Patients were categorized by platelet levels and bleeding manifestations and data were analyzed using SPSS version 26. Results: A total of 140 patients with a mean age of 44.23 ± 11.95 years were included in the study. Bleeding manifestations were observed in 57.1% of patients, categorized as single-site bleeding in 36.4% and multiple-site bleeding in 20.7%. Petechiae were the most common manifestation (52.1%), followed by purpura (39.3%) and gum bleeding (37.1%). Severe thrombocytopenia was significantly associated with petechiae (65.6%, p=0.042) and purpura (75.0%, p=0.000), while melena was more frequent in mild thrombocytopenia (35.6%, p=0.000). Hematuria and bleeding gums were significantly correlated with moderate thrombocytopenia (42.9%, p=0.018; 38.1%, p=0.036, respectively). Bleeding status showed no significant trend across platelet count categories (p=0.198). Conclusions: Thrombocytopenia severity is significantly associated with specific bleeding manifestations in dengue patients, highlighting the need for vigilant platelet monitoring to mitigate complications.

BackgroundChronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count < 50,000/µL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count in such patients when invasive procedures are scheduled. Former studies on lusutrombopag included patients with a platelet count of > 50,000/µL at baseline: the proportions of patients who did not require platelet transfusion were 84–96%, which might be overestimated.MethodsThe efficacy and safety of lusutrombopag were retrospectively investigated in CLD patients with platelet count of < 50,000/µL, a criterion for platelet transfusion, in real-world settings. We examined the proportion of patients who did not require platelet transfusion in 31 CLD patients, which exceeded a minimum required sample size (21 patients) calculated by 80% power at a significance level of 5%. Lusutrombopag, 3 mg once daily, was administered 8–18 days before scheduled invasive procedures.ResultsAmong 31 patients who received lusutrombopag, 23 patients (74.2%) patients showed a platelet count of ≥ 50,000/µL (Group A) and did not require platelet transfusion. The remaining 8 patients (25.8%) did not reached platelet ≥ 50,000/µL (Group B). The means of platelet increase were 38,000/µL and 12,000/µL in groups A and B, respectively. A low platelet count at baseline was a characteristic of patients in group B. Among 13 patients who repeatedly used lusutrombopag, lusutrombopag significantly increased the platelet count as the initial treatment. When all repeated uses of lusutrombopag were counted among these 13 patients, platelet transfusion was not required in 82.1% (23/28) of treatments. Although one patient showed portal thrombosis after lusutrombopag treatment, the thrombosis was disappeared by anticoagulant treatment for 35 days. The degree of platelet increase with lusutrombopag was larger than that in their previous platelet transfusion.ConclusionsThe proportion of patients who did not require platelet transfusion was 74.2%, which is smaller than that in former studies which included CLD patients with a platelet count of > 50,000/µL. However, lusutrombopag is effective and safe for CLD patients with a platelet count of < 50,000/µL.

Cost-Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease

Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/μL. Studies of bronchoscopy in thrombocytopenia are limited. Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/μL. We performed a retrospective review of all flexible bronchoscopies between June 1, 2008 and December 31, 2010. Biopsies and therapeutic procedures were excluded. The χ, Fisher exact, and Rank-sum test were conducted to evaluate associations of clinically significant bleeding. There were 1711 patients who underwent 2053 flexible bronchoscopies. Cancer diagnosis included hematologic (61.3%) and solid organ malignancy (34.9%). Half of the bronchoscopies had moderate to severe thrombocytopenia (<100 K/μL) with the following ranges: 14.7% with 50 to <100 K/μL, 20.6% with 20 to <50 K/μL, 10.6% with 10 to <20 K/μL, 4.1% with <10 K/μL. Platelet transfusion was given in 90.6% of those with platelets <10 K/μL and 55.5% of those with platelets 10 to <20 K/μL. The nasal route for bronchoscopy was used in 92.4%. Bleeding complication rate however was 1.1% (0.2% major) and not affected by platelets. Bronchoscopy with lavage can be safely performed without platelet transfusion in those with platelets of ≥10 K/μL. In the absence of nasal bleeding, trauma, or deformity, the nasal route can be used for bronchoscopy.

A 62-year-old Caucasian female who had recently been diagnosed with multiple myeloma with a sacral plasmacytoma received induction treatment with bortezomib, cyclophosphamide, and dexamethasone. She had a significant response to therapy and had just begun the process of mobilization and collection of peripheral blood progenitor cells for autologous stem cell transplantation when she presented to the emergency center (EC) with pain and swelling of the left upper extremity. Her blood pressure on presentation was 114/69 mmHg with a heart rate of 98 beats per minute. Serum sodium was 136 mEq/L, potassium 4.3 mEq/L, chloride 98 mEq/L, carbon dioxide 24 mEq/L, blood urea nitrogen 9 mg/dL, serum creatinine 0.6 mg/dL, glucose 119 mg/dL, calcium 8.6 mg/dL, albumin 3.9 mg/dL, phosphorus 2.5 mg/dL, and magnesium 2.1 mg/dL. Liver function tests were within normal limits, with the exception of lactate dehydrogenase that was elevated at 728 IU/L. Prothrombin time (PT) was 16.5 sec (normal 12.7―15 sec), international normalized ratio (INR) 1.24, and activated PTT (aPTT) was 38.3 sec (normal 24.7―35.9 sec). D-dimer was >20 μg/mL (normal 0―0.4 μg/dL) and fibrinogen was 424 mg/dL. A complete blood count (CBC) showed a white blood cell (WBC) count of 11,400/μL, hemoglobin of 11.6 g/dL, and platelet count of 14,000/μL. Review of the peripheral smear revealed the presence of anisocytosis and ovalocytes, and the absence of fragmented red blood cells (schistocytes). The platelet count had dropped from 316,000/μL to 14,000/μL in a 7-day period (see Fig. 1). Home medications included zolpidem, lorazepam, duloxetine, famotidine, fentanyl, hydromorphone, and ondansetron. Doppler ultrasound study showed a completely occlusive thrombus within the left internal jugular vein extending to the subclavian, axillary, brachial, and basilic veins. The patient had recently had a left subclavian central venous catheter (CVC) placed 11 days prior to presenting to the EC. The CVC was removed, but no anticoagulation was started secondary to severe thrombocytopenia.

Idiopathic Thrombocytopenic Purpura

Background: Thrombocytopenia is the most common cause of abnormal bleeding. Thrombocytopenia develops when there is profound disequilibrium in the balance between platelet production, distribution and destruction. More than one component may be affected in some disorder. Aim: To evaluate clinical profile, etiological profile and outcome of febrile thrombocytopenia and to determine the relationship between platelet count and the occurrence and severity of bleeding Materials and Methods: 393 patients, aged more than 12 years, presented with febrile thrombocytopenia were observed for occurrence of bleeding manifestations, investigated in detail and treated symptomatically and specifically after definite diagnosis. Results: Age and Sex distribution: Febrile thrombocytopenia affects all age groups but was more common in 12-30 years age group (62.34%).Male (69.97%) outnumbered Female (30.07%) in this study. Its incidence increased 71.24% during the month of September to December, 2015. Etiology of disease: Dengue fever (55.98%), Malaria (25.95%) were the common etiologies of febrile thrombocytopenia in present study. Platelet count and bleeding manifestations: 45.29% patients with platelet count >50000/mm3 mild thrombocytopenia); 38.17% with platelet count 20000-50000/mm3 (moderate thrombocytopenia) and 16.54% with platelet count less than 20000/mm3 (severe thrombocytopenia) were recorded. Bleeding manifestations were recorded in 98.46%, 54%, 17.97% cases of severe, moderate and mild thrombocytopenia respectively. Outcome: 94.15% patients had good recovery. Conclusion: Risk of bleeding increase when platelet count decreases below 20000.There was no absolute relationship between platelet count and severity of bleeding.