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Investigations in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Investigations will be influenced by any presumed aetiology, but include:

  • repeat FBC and request blood film
    • this is in order to confirm thrombocytopenia is real - also this will exclude other diseases such as chronic lymphocytic leukaemia and myelodysplastic syndromes
  • renal biochemistry
  • liver function tests (liver disease)
  • viral serology (EBV, hepatitis screen); consider HIV
  • autoantibodies - thrombocytopenia may occur in conditions such as SLE
  • B12, folate - deficiency may result in pancytopenia or cytopenia of particular cell line
  • immunoglobulins - to exclude common variable immunodeficiency
  • clotting studies - also related to liver function

Bone marrow will be a secondary care investigation.

Notes:

  • if thrombocytopaenia is drug-induced then platelet counts will recover 5-7 days after stopping the incriminated drug
  • if platelet count is < 30x10^9/l then this is an indication for stopping antiplatelet medication e.g. aspirin, clopidogrel (2)
  • examine for splenomegaly
  • if patient >60x109/l then should consider myelodysplasia as possible cause (3)
  • gestational thrombocytopenia (GT) is considered the most prevalent cause of thrombocytopaenia in pregnancy
    • accounts for about 75% of cases of thrombocytopenia during pregnancy
    • defined by a platelet count of no less than 70 × 10^9/l, particularly during the third trimester

Reference:

  1. GP magazine (August 8th 2004): 33-4.
  2. George, J.N. For low platelets, how low is dangerous? Cleveland Clinic Journal of Medicine 2004;71(4): 277-278.
  3. American Society of Hematology.Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. Annals of Internal Medicine 1997;126(4): 319-326.
  4. Kam PC et al. Thrombocytopenia in the parturient, Anaesthesia 2004;59:255–264.

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