Signs and symptoms: Signs and symptoms include a sudden onset of petechiae in the skin and bleeding into any mucous membranes. Patients may have malaise, fatigue and general weakness. In adults, there may be large blood-filled blisters in the mouth. In severe disease, hemorrhage may lead to tachycardia, shortness of breath, loss of consciousness, and death. Diagnosis:
Prognosis is good in drug-induced thrombocytopenia if the offending drug is withdrawn such as heparin for HIT. Recovery can be immediate. In other cases, the prognosis depends on the patient’s response to treatment of the underlying cause. Diagnostic tests will show that a platelet count is decreased usually to less than 100,000 in adults. Bleeding time may be prolonged. PT and PTT normal. Platelet antibody studies can be used to explain why the platelet count is low and can also be used to select the treatment. Platelet survival studies can help with differentiating between ineffective platelet production and platelet destruction as caused of the platelet thrombocytopenia. Bone marrow studies can determine the number, size and cytoplasm maturity of the megakaryocytes in severe disease and this helps to identify ineffective platelet production as the cause and rules out malignant disease at the same time. Treatment: Treatment includes the withdrawal of the offending drug if the thrombocytopenia is drug related. Treatment may also include administration of corticosteroids to increase platelet production. Administration of foley may be used to stimulate bone marrow to produce more platelets. IV administration of gamma globulin for severe or refractory thrombocytopenia. A platelet transfusion may be used to stop episodic abnormal bleeding caused by a low platelet count. It is only minimally effective is platelet destruction results from an immune disorder. It should be reserved for life-threatening bleeding. A splenectomy to correct disease caused by platelet destruction because the spleen acts as the primary site of platelet removal and antibody production. HIT (Heparin-Induced Thrombocytopenia): HIT is prevalent in the hospital and is very common cause of thrombocytopenia. It is an immune-mediated adverse drug reaction to heparin. IgG antibodies bind to platelets receptors and activate platelet aggregation forming clots that decrease the platelet count because they are all stuck together. Treatment is stopping the heparin and if the patient still needs treatment with an anti-coagulant then a medication besides heparin must be used. ITP (Idiopathic Thrombocytopenia Purpura): Description: ITP is an autoimmune disorder, antibodies that reduce the lifespan of platelets appear in nearly all the patients. It results from immunologic platelet destruction. There are 2 types of ITP: 1.Acute ITP: also called post-viral thrombocytopenia usually affects kids between the ages of 2-6 and usually the viral disease is Chickenpox or Rubella. 2.Chronic ITP: also called Werlhof disease and is autoimmune thrombocytopenia and affects adults younger than the age of 50. Especially women between the ages of 20-40. Chronic ITP seldom follows an infection but is rather linked with immunologic disorders such as lupus and HIV. An IgG autoantibody binds with the platelets and destroys them. Normally platelets live for about 7-10 days but in ITP they only live for 1-3 days.