IV. Causes: Common by Timing

  1. Acute
    1. Bone Marrow suppression by Chemotherapy or radiation
    2. Bone Marrow infiltration by malignancy
    3. Viral Infections (e.g. CMV, EBV, VZV, HIV, HCV, Parvovirus B19)
    4. Acute Leukemia
    5. Aplastic Anemia
    6. Drug-Induced Thrombocytopenia
    7. Preeclampsia with HELLP Syndrome
    8. Heparin Induced Thrombocytopenia
    9. Thrombotic Thrombocytopenic Purpura or Hemolytic Uremic Syndrome
  2. Chronic
    1. Alcohol Abuse
    2. Congenital Disorders (see hereditary decreased platelet disorders below)
    3. Immune Thrombocytopenic Purpura
    4. Cirrhosis or other liver disorder
    5. Myelodysplastic Syndrome

V. Causes: Children

VI. Causes: Platelet Destruction

  1. Immune-Mediated
    1. Drug induced Thrombocytopenia
    2. Heparin-Induced Thrombocytopenia
    3. Idiopathic Thrombocytopenic Purpura (ITP)
    4. Post-Transfusion (within 5 to 14 days)
    5. Vasculitis
    6. Autoimmune Hemolytic Anemia
    7. Chronic Lymphocytic Leukemia (CLL)
    8. Antiphospholipid Syndrome
    9. Systemic Lupus Erythematosus (SLE) in 10% of cases
    10. Sarcoidosis
    11. Lymphoma
    12. Human Immunodeficiency Virus (HIV)
    13. Cytomegalovirus (CMV)
    14. Herpes Virus infection
  2. Immune-Mediated in Newborns
    1. Fetal - maternal ABO incompatibility
    2. Neonatal isoimmune or alloimmune Thrombocytopenia
      1. Maternal Antibody to fetal platelet antigen (P1)
    3. Neonatal autoimmune Thrombocytopenia
      1. Maternal Antibody binds fetal platelets
      2. Maternal conditions
        1. Idiopathic Thrombocytopenic Purpura
        2. Systemic Lupus Erythematosus
        3. Drug induced Thrombocytopenia
  3. Non-immune Mediated
    1. Preeclampsia (HELLP Syndrome)
    2. Prosthetic Heart Valves (e.g. aortic Valve Replacement)
    3. Thrombotic Thrombocytopenic Purpura (TTP)
    4. Sepsis
    5. Disseminated Intravascular Coagulation (DIC)
    6. Hemolytic Uremic Syndrome (HUS)
    7. Hemorrhage with extensive transfusion

VII. Causes: Decreased Platelet Production

  1. Acquired
    1. Infiltrative process
      1. Leukemia
      2. Histiocytosis
      3. Lymphoma
      4. Myelodysplastic Syndrome
      5. Myelofibrosis
      6. Storage disease
      7. Neuroblastoma
      8. Granulomatosis
      9. Osteopetrosis
    2. Suppression of Megakaryocytes (or Bone Marrow failure)
      1. Alcohol Abuse
      2. Radiation
      3. Infection
        1. Fetal TORCH Virus infection
        2. Cytomegalovirus
        3. Epstein-Barr Virus (Mononucleosis)
        4. Varicella Zoster Virus
        5. Hepatitis C virus
        6. HIV Infection
        7. Mumps
        8. Parvovirus B19
        9. Rickettsia
        10. Rubella
      4. Paroxysmal Nocturnal Hemoglobinuria
      5. Scwachman-Diamond Syndrome
      6. Medications
        1. See Drug induced Thrombocytopenia
        2. Alkylating Agents
        3. Antimetabolites
        4. Anticonvulsants
        5. Hydrochlorothiazide or other Thiazide Diuretics
        6. Estrogen
      7. Aplastic Anemia
  2. Hereditary
    1. Alport Syndrome
    2. Bernard-Soulier Syndrome
    3. Thrombocytopenia-absent radii (TAR syndrome)
      1. Autosomal Recessive trait
      2. Purpura immediately or within weeks of birth
    4. Fanconi Anemia
    5. Wiskott-Aldrich syndrome (x-linked condition)
      1. Decreased platelets (Microthrombocytopenia)
        1. Adequate Megakaryocytes in Bone Marrow
      2. Eczematous Dermatitis
      3. Repeated infection (Immunodeficiency)
    6. May-Hegglin anomaly
      1. Increased Megakaryocytes
      2. Ineffective thrombopoiesis
    7. Congenital amegakaryocytic Thrombocytopenia
      1. Rare isolated newborn Thrombocytopenia

VIII. Causes: Platelet sequestration and miscellaneous causes

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