Laboratory procedures following thrombocytopenia diagnosis

Česká verzia

Authors: L. Šáchová; A. Urgasová; J. Gumulec
Authors place of work: Hemato-onkologické a transfuzní centrum FN Ostrava, přednosta prim. MUDr. Jaromír Gumulec
Published in the journal: Vnitř Lék 2009; 55(3): 290-294
Category: 15th Parizek's Days

Summary

Thrombocytopenia – decrease in the blood platelets count below 100 × 10⁹/L – may represent a significant clinical complication – bleeding. A risk of haemorrhagic complications increases with the severity of thrombocytopenia. Even severe thrombocytopenia, however, may be a sign of a condition with predominant symptoms of thrombosis where bleeding is on the background (thrombotic microangiopathy, for example) or where bleeding occurs concurrently with symptoms of thrombosis (so called thrombohaemorrhagic syndromes). It is necessary to exclude pseudothrombocytopenia when thrombocytopenia is first diagnosed. It is then recommended to follow a standardized differential diagnosis algorithm that should be available at each clinical site. We summarize the general rules of thrombocytopenia differential diagnosis with a specific focus on laboratory processes.

Key words:
thrombocytopenia – pseudothrombocytopenia – differential diagnosis

Zdroje

1. Elting LS, Rubenstein EB, Martin CG et al. Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy‑induced thrombocytopenia. J Clin Oncol 2001; 19: 1137–1146.

2. Shanafelt TD, Fonseca R. Thrombocytopenia. In: Oliveira GHM, Nesbit GC, Murphy JG. Mayo Clinic Medical Manual. Mayo Clinic Scientific Press 2006.

3. Guidelines on the Diagnosis and Management of the Thrombotic Microangiopathic Haemolytic Anaemias. Br J Haematol 2003; 120: 556–573.

4. Warkentin T, Greinacher A, Lincoff AM et al. Treatment and Prevention of Heparin‑Induced Thrombocytopenia: American College of Chest Physicians of Chest Physicians Evidence-Based Clinical Practice Guidelines. 8th ed. Chest 2008; 340S–380S.

5. Payne BA, Pierre RV. Pseudotrombocytopenia: A laboratory artifact with potentially serious complications consequences. Mayo Clin Proc 1984; 59: 123–125.

6. Berkman N, Michaeli Y, Or R et al. EDTA-dependent pseudothrombocytopenia: A clinical study of 18 patients and a review of the literature. Am J Hematol 1991; 36: 195–201.

7. Schrezenmeier H, Müller H, Gunsilius E et al. Anticoagulant‑induced pseudothrombocytopenia and pseudoleucocytosis. Thromb Haemost 1995; 73: 506–513.

8. Bizzaro N. Platelet satellitosis to polymorphonuclears: Cytochemical, imunological, and ultrastructural characterization of eight cases. Am J Hematol 1991; 36: 235–242.

9. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Hematol 2003; 120: 556–557.

10. Mayer SA, LM. Aledort Thrombotic Microangiopathy: Differential Diagnosis, Pathophysiology and Therapeutic Strategies. Mt Sinai J Med 2005; 72: 166–175.

11. Nguyen TC, Carcillo JA. Bench-to-bedside review: Thrombocytopenia‑associated multiple organ failure – a newly appreciated syndrome in the critically ill. Critical Care 2006; 10: 235–242.

12. Levi M, Opal SM. Coagulation abnormalities in critically ill patients. Critical Care 2006; 10: 222–230.

13. Espinosa G, Bucciarelli S, Cervera R et al. Thrombotic microangiopathic haemolytic anemia and antiphospholipid antibodies. Ann Rev Rheum Dis 2004; 63: 730–736.

14. Taylor FBJ, Toh CH, Hoots WK et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86: 1327–1330.

15. Krejčí M, Šmardová J, Adam Z. Akutní myeloidní leukemia. In: Adam Z, Krejčí M, Vorlíčk J et al. Hematologie, přehled maligních hematologických onemocnění. 2. dopl. a zcela přepr. vyd. Praha: Grada Publishing 2008; 29–38.

16. Miyakis S, Lockshin MD, Atsumi T et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2005; 4: 295–306.

17. Nové informace OLM MOU. Dostupnost na www.mou.cz/section.

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