Thrombocytopenia natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2], Farbod Zahedi Tajrishi, M.D. [2]

Overview

As thrombocytopenia is not an individual disease and has a wide variety of causes, it can produce different natural histories, complications and prognoses. Based on its underlying cause, it can remain assymptomatic and regress spontaneously, or it could develop to be accompanied by chronic diseases such as SLE and even life-threatening malignancies.

Natural History

Studies on the natural history of thrombocytopenia are limited and the natural history itself depends enormously on the underlying cause of thrombocytopenia. Studies had shown that the following complications/prognosis is probable in patients with asymptomatic mild thrombocytopenia:^[1]

Return to normal platelet status
Developing MDS
Developing SLE
Remain asymptomatic

After five years of follow-up, the majority of participants (64 percent) either experienced:

Spontaneous resolution of thrombocytopenia, or
Persistent mild thrombocytopenia without development of an associated condition, suggesting a diagnosis of ITP.

Complications

Depending on the underlying cause, the complications of thrombocytopenia include a variety of conditions from no complications at all or easy bruising to severe life-threatening conditions

Prognosis

Generally, the prognosis of thrombocytopenia depends on its underlying cause. In acute coronary syndrome trials and ST elevation MI trials, thrombocytopenia has been associated with an increase risk of major bleeding, transfusion, recurrent MI, stroke and both in-hosptial and 30 day mortality. ^[2]^[3]^[4]^[5]

References

↑ Stasi R, Amadori S, Osborn J, Newland AC, Provan D (2006). “Long-term outcome of otherwise healthy individuals with incidentally discovered borderline thrombocytopenia”. PLoS Med. 3 (3): e24. doi:10.1371/journal.pmed.0030024. PMC 1326262. PMID 16401142.
↑ Gore JM, Spencer FA, Gurfinkel EP, López-Sendón J, Steg PG, Granger CB, FitzGerald G, Agnelli G (2009). “Thrombocytopenia in patients with an acute coronary syndrome (from the Global Registry of Acute Coronary Events [GRACE])”. The American Journal of Cardiology. 103 (2): 175–80. doi:10.1016/j.amjcard.2008.08.055. PMID 19121432. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)
↑ Merlini PA, Rossi M, Menozzi A, Buratti S, Brennan DM, Moliterno DJ, Topol EJ, Ardissino D (2004). “Thrombocytopenia caused by abciximab or tirofiban and its association with clinical outcome in patients undergoing coronary stenting”. Circulation. 109 (18): 2203–6. doi:10.1161/01.CIR.0000127867.41621.85. PMID 15117843. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)
↑ Nikolsky E, Sadeghi HM, Effron MB, Mehran R, Lansky AJ, Na Y, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Stuckey TD, Turco M, Carroll JD, Grines CL, Stone GW (2005). “Impact of in-hospital acquired thrombocytopenia in patients undergoing primary angioplasty for acute myocardial infarction”. The American Journal of Cardiology. 96 (4): 474–81. doi:10.1016/j.amjcard.2005.04.005. PMID 16098296. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)
↑ Wang TY, Ou FS, Roe MT, Harrington RA, Ohman EM, Gibler WB, Peterson ED (2009). “Incidence and prognostic significance of thrombocytopenia developed during acute coronary syndrome in contemporary clinical practice”. Circulation. 119 (18): 2454–62. doi:10.1161/CIRCULATIONAHA.108.827162. PMID 19398666. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)

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[pmid16401142-1] Stasi R, Amadori S, Osborn J, Newland AC, Provan D (2006). “Long-term outcome of otherwise healthy individuals with incidentally discovered borderline thrombocytopenia”. PLoS Med. 3 (3): e24. doi:10.1371/journal.pmed.0030024. PMC 1326262. PMID 16401142.

[pmid19121432-2] Gore JM, Spencer FA, Gurfinkel EP, López-Sendón J, Steg PG, Granger CB, FitzGerald G, Agnelli G (2009). “Thrombocytopenia in patients with an acute coronary syndrome (from the Global Registry of Acute Coronary Events [GRACE])”. The American Journal of Cardiology. 103 (2): 175–80. doi:10.1016/j.amjcard.2008.08.055. PMID 19121432. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)

[pmid15117843-3] Merlini PA, Rossi M, Menozzi A, Buratti S, Brennan DM, Moliterno DJ, Topol EJ, Ardissino D (2004). “Thrombocytopenia caused by abciximab or tirofiban and its association with clinical outcome in patients undergoing coronary stenting”. Circulation. 109 (18): 2203–6. doi:10.1161/01.CIR.0000127867.41621.85. PMID 15117843. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)

[pmid16098296-4] Nikolsky E, Sadeghi HM, Effron MB, Mehran R, Lansky AJ, Na Y, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Stuckey TD, Turco M, Carroll JD, Grines CL, Stone GW (2005). “Impact of in-hospital acquired thrombocytopenia in patients undergoing primary angioplasty for acute myocardial infarction”. The American Journal of Cardiology. 96 (4): 474–81. doi:10.1016/j.amjcard.2005.04.005. PMID 16098296. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)

[pmid19398666-5] Wang TY, Ou FS, Roe MT, Harrington RA, Ohman EM, Gibler WB, Peterson ED (2009). “Incidence and prognostic significance of thrombocytopenia developed during acute coronary syndrome in contemporary clinical practice”. Circulation. 119 (18): 2454–62. doi:10.1161/CIRCULATIONAHA.108.827162. PMID 19398666. Retrieved 2010-06-30. Unknown parameter |month= ignored (help)

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