Children

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Thrombocytopenia

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Updated by: Dr. Julie Panepinto and Dr. Paul Scott
Updated on: 5/9/2017

Definition

A condition in which the patient has a low blood platelet count. Normal platelet count is 150,000 to 400,000 throughout childhood.

Diagnosis/symptom

Signs and symptoms:

  • Onset, Bleeding site, Severity
  • Acute: petechiae, purpura, epistaxis, menorrhagia
  • Chronic: easy bruising, epistaxis, prolonged and/or frequent menstrual bleeding

Causes

  • ITP, most common cause of acute thrombocytopenia children in otherwise well child
  • Consumptive coagulopathy (DIC, HUS, TTP) in moderate to severely ill chill children
  • Chronic thrombocytopenic syndromes, likely genetic and etiology in a well-child with chronic thrombocytopenia

Referring provider’s initial evaluation and management:

Diagnosis and Treatment (diagnosis is dependent):

  • For acute ITP: observation, acute steroid burst, IVIG
  • For chronic states: episodic platelet transfusion, immune suppressive medications such as rituxan, splenectomy depending on reason for thrombocytopenia, thrombopoietin-receptor mimetics

Initial evaluation and therapy:

  • History and physical exam
  • CBC, differential, Coagulation studies

When to initiate referral/ consider refer to Hematology Clinic:

  • Sudden onset of moderate- severe thrombocytopenia (<20,000 platelets)
  • Chronic thrombocytopenia of unknown cause
  • Thrombocytopenic patient with uncontrolled bleeding
  • Thrombocytopenic patient to undergo surgical intervention

What can referring provider send to Hematology Clinic?

1. Using Epic

  • Please complete the external referral order In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:
    • Urgency of the referral
    • What is the key question you would like answered?

Note: Our office will call to schedule the appointment with the patient.

2. Not using Epic external referral order:

  • In order to help triage our patients maximize the visit time, please fax the above information to (414-607-5288)
  • It would also be helpful to include:
  • Chief complaint, onset, frequency 
  • Recent progress notes
  • Labs and imaging results
  • Other Diagnoses
  • Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient’s problems.

Specialist’s workup will likely include:

  • CBC, differential, and reticulocyte count and smear
  • Consideration of coagulation studies
  • Genetic analysis for chronic thrombocytopenia syndromes
  • More than one cell line is involved, consideration of bone marrow aspiration biopsy
  • ANA, HIV studies for new onset ITP in an adolescent After referral to Hematology Clinic:
  • For acute ITP: CBC to be followed at local clinic with phone contacts between primary physician’s office and pediatric hematology
  • For chronic thrombocytopenic syndromes: observation with eventual genetic testing to be performed if thrombocytopenia persists for greater than one year and there is no preexisting history of a normal platelet count.
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