Byline: S. Akin, I. Haznedaroglu
Background: Thrombocytopenia is defined as the platelet count of less than 150 x 109/L and is a prominent cause of bleeding. Aplastic anemia (AA), immune thrombocytopenic purpura (ITP), and thrombotic thrombocytopenic purpura (TTP) are some of the reasons of low platelet counts. Aims: We aimed to interpret different laboratory and clinical findings in these different reasons of thrombocytopenia. Methods: Among patients with these disorders we assessed the performance of the ITP Bleeding Scale Assessment (ITP-BSA), which is principally designed for ITP patients. Results: A hundred patients were included in analysis. Median platelet count at presentation was similar in all three groups. Thrombosis was seen more common in patients with TTP (20.7%) than the others (ITP; 5.6%, AA; 2.9%). In patients with TTP, sepsis (41.4%) and neurological findings (89.7%) are also more common than in the patients with ITP or AA. Bleeding was determined in all patients with AA. However, 13 patients with ITP (%36.1) and 10 patients with TTP (%34.5) had no bleeding. The most common bleeding site was skin in all three groups. There was not any gastrointestinal, lung, genitourinary, and cranial bleeding in patients with ITP. Patients with AA obtained the highest scores from the ITP-BSA. There was a significant difference between AA and the other two groups. The scores were found similar in patients with ITP and TTP (P = 0.17). Conclusion: Clinical variations in thrombocytopenic patients may vary and assist to diagnose the cause of thrombocytopenia. The bleeding scoring systems might be helpful.
Introduction
Thrombocytopenia is defined as the platelet count of less than 150 x 109/L and is a prominent cause of bleeding. Many factors can cause thrombocytopenia such as bone marrow disorders, destroying of platelets, hypersplenism, or combination of these conditions.[1] Although severe thrombocytopenia (<50 x 109/L) confers a greater risk of bleeding, the correlation between the platelet count and the risk of bleeding varies according to the underlying condition and may be unpredictable because of some other factors such as platelet function.[2]
Aplastic anemia (AA) is an uncommon but severe blood disorder that is a prototype of diminished production. In case of AA, bone marrow does not produce erythrocytes and platelets as well.[3] Moreover, other series of bone marrow also paused, so anemia and leucopenia are also other features of AA. As a result, patients may have fatigue and frequent or prolonged infections with sepsis.[4] Immune thrombocytopenic purpura (ITP) is one of the most common reasons of thrombocytopenia without systemic illness, in which immune system mistakenly attacks platelets and destroys them.[5] In the pathogenesis of ITP, CD40 gene SNP rs1883832 is associated with an increased risk of ITP development.[6] Thrombotic thrombocytopenic purpura (TTP) is also a rare and life-threatening disorder characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA), and is often associated with fever, neurological signs, and renal failure.[7] The latter two reasons of thrombocytopenia are examples of increased destruction. Accompanying clinical problems assist to diagnose the accurate cause of thrombocytopenia.
A method for objective evaluation of bleeding...