{"id":4463,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/thrombocytopenia\/"},"modified":"2024-09-04T14:51:10","modified_gmt":"2024-09-04T13:51:10","slug":"thrombocytopenia","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/thrombocytopenia\/","title":{"rendered":"Thrombocytopenia"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Definition<\/h4>\n\n\n\n<p>Isolated platelet count below the normal range. For patients with bi- or pancytopenia refer to the appropriate RefHelp page.<\/p>\n\n\n\n<p>Please also see the guidance on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/thrombocytopeniainpregnancy\/\">thrombocytopenia in pregnancy<\/a>. &nbsp;<\/p>\n\n\n\n<p>Please note:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Thrombocytopenia can be drug-induced, therefore review all medication and consider discontinuing any drugs that might be implicated<\/li>\n\n\n\n<li>Drugs most often associated with thrombocytopenia include:\n<ul class=\"wp-block-list\">\n<li>heparin (including LMWH)<\/li>\n\n\n\n<li>quinine<\/li>\n\n\n\n<li>bendroflumethiazide<\/li>\n\n\n\n<li>sulphonamides<\/li>\n\n\n\n<li>sulphonylureas<\/li>\n\n\n\n<li>phenytoin<\/li>\n\n\n\n<li>methotrexate<\/li>\n\n\n\n<li>ranitidine<\/li>\n\n\n\n<li>NSAIDs.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Heparin induced thrombocytopenia (HIT) \u2013 please see below for detail.<\/li>\n\n\n\n<li>For patients with a high alcohol intake, it may be appropriate to repeat the FBC to see if thrombocytopenia has resolved following a period of abstinence.<\/li>\n\n\n\n<li>For patients with a high alcohol intake, deranged LFTs +\/- USS abdomen, consider GI referral initially.<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Heparin Induced Thrombocytopenia (HIT)<\/u><\/strong><\/p>\n\n\n\n<p>This is a rare complication associated with significant risk of thrombosis. It usually occurs within 15 days of starting heparin\/LMWH.&nbsp; If the platelet count is low &#8211; or has dropped by more than 50% &#8211; since heparin initiation, please discuss the case with the on-call haematology registrar.<\/p>\n\n\n\n<p><strong>C.M &amp; L.W 26-03-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with platelet counts &lt;100<\/li>\n\n\n\n<li>Urgent referral for patients with platelet counts &lt;20 (contact on-call Haematology registrar)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Isolated thrombocytopenia if platelet count &gt;100, no other cytopenias and no accompanying clinical findings of concern such as the presence of lymphadenopathy or splenomegaly.<\/li>\n\n\n\n<li>If platelet count &gt;100 repeat at 6 months and if remains &gt;100 there is no requirement for routine monitoring.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway to the Department of Haematology RIE, WGH or SJH.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Primary care investigations<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assess patient for symptoms of bleeding and easy or spontaneous bruising<\/li>\n\n\n\n<li>Review medication (see above)<\/li>\n\n\n\n<li>Take alcohol history<\/li>\n\n\n\n<li>Examine for lymphadenopathy and splenomegaly<\/li>\n\n\n\n<li>Blood film<\/li>\n\n\n\n<li>B12 and folate. Treat if deficiency is detected<\/li>\n\n\n\n<li>LFTs inc GGT. Consider US abdominal ultrasound scan, if abnormal<\/li>\n\n\n\n<li>HIV and HCV serology<\/li>\n\n\n\n<li>If additional clinical features to suggest a diagnosis of SLE, RA or other connective tissue disorder check CCP, ANF, dsDNA (if ANF positive)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\"><\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Definition Isolated platelet count below the normal range. For patients with bi- or pancytopenia refer to the appropriate RefHelp page. Please also see the guidance on thrombocytopenia in pregnancy. &nbsp; Please note: Heparin Induced Thrombocytopenia (HIT) This is a rare complication associated with significant risk of thrombosis. It usually occurs within 15 days of starting<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3981,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[274],"class_list":["post-4463","page","type-page","status-publish","hentry","category-thrombocytopenia"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/thrombocytopenia\/\" rel=\"tag\">Thrombocytopenia<\/a>","rttpg_excerpt":"Definition Isolated platelet count below the normal range. For patients with bi- or pancytopenia refer to the appropriate RefHelp page. Please also see the guidance on thrombocytopenia in pregnancy. &nbsp; Please note: Heparin Induced Thrombocytopenia (HIT) This is a rare complication associated with significant risk of thrombosis. It usually occurs within 15 days of starting","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4463","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4463"}],"version-history":[{"count":11,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4463\/revisions"}],"predecessor-version":[{"id":20706,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4463\/revisions\/20706"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3981"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4463"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4463"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}