Bleeding Time

Approach to Patient suspected with

THROMBOCYTOPENIA

High- Increased
Platelet
Destruction

Increased

KEY
TEST:

RED

RESULT: BLUE
Blood test/Full Blood
Count:
Thrombocytopenia:
Platelet count
<150,000 uL

Mean Platelet
Volume

Low- Production
Problem

CONDITION: GREEN

Previous History of
Thrombocytopenia
Platelet
Sequestration

Physical Examination
focus on finding the presence
of bleeding in the skin, mucous
membranes, brain, urinary tract

Enlarged spleen
Urinary bleeding

Decreased neutrophils,

liver function
tests AST, ALT,
increased

LDH, Haptoglobulin,
bilirubin, unconjugated

Liver cirrhosis
Is high

Increased=H
aemolysis

Thrombotic
Thrombocytopenia
Purpura and DIC

SEQUESTRATION/POOLIN
G
Kidney and
Urine Tests
Coombs test

Differential : PT, PTT, fibrin,

fibrinogen, D-Dimer (Coagulation
Panel).
.

ACCELERATED DESTRUCTION

NORMAL
PROLONGED

Repeat Platelet
count using
citrated blood

EXAMINE PERIPHERAL BLOOD SMEAR: Look for specific Diagnostic clues ?

PANCTOPENIA,

MCV

Vitamin B12 assay

FURTHER clinical tests AND AEITIOLOGICAL

SPECIFIC TESTS

Schiscotyes
Thrombotic
Thrombocytopenia
Pupura,
Disseminated
Intravascular
Coagulation

Spherocytes

Autoimmune
Haemolytic
anaemia

Negative

DIC

BONE MARROW
BIOPSY
DISORDERS
Leukemia
Tumour fibrosis
Myeloproliferative
disorder
Lymphoma

Elevated
Creatinine kinase

TTP

Toxic granules
Atypical Lymphocytes
Blast cells, Tear drop
shaped cells.

Normal

PSUEDOTHROMBOCYTOPENIA

Leukocytes

Assess

Reticulocyte
Count

Evaluate patient nutrition

Vitamin deficiency- B12

Megaloblastic anemia

Erythrocytes
Hb

Medical History
- Familial History
- Medications
- HIV risk factor
- Liver Disease

Intercranial bleeding

Thrombotic
thrombocytopenia
purpura

May show anemia

No Previous History of
thrombocytopenia

Ultrasonography

Disseminated
Intravascular
Coagulation

AND

CLASSIFICATION: PURPLE

Repeat

Routine Blood
Count

Platelets

In vitro Platelet clumps

associated with EDTA

NORMAL
Normal- Large Platelets
Patient on
Heparin
Confirm Antibodies
to PF4 complex
FLIFA assay, SRA

Giant platelets

HIV RISK

CD4 T-cell
count

DECREASED
Antibodies detected
Heparin induced
thrombocytopenia

Inherited
Thrombocytopenia
PCR FOR MUTATION
TESTING

HIV

DEFICIENT PRODUCTION

Idiopathic thrombocytopenia
purpura: DIAGNOSIS OF
EXCLUSION
ELISA: confirm IgG antibodies
against platelet membrane

ACCELERATED DESTRUCTION

Bernard-Soulier syndrome
Deletion in GP1BB
May Hegglin Anomaly
MYH9 gene
Macrothrombocytopenia
2 base mutation Gly208 of GATA-1
detected by restriction fragment
length polymorphism

ACCELERATED DESTRUCTION
ADAMTS13
deficiency TEST

LABORATORY PCR
ADAMTAS3MUTATION
DETECTION, confirmation

DEFICIENT PRODUCTION