Thrombocytopenia history and symptoms

Since a broad spectrum of conditions can result in thrombocytopenia, an accurate history could be of great benefit in identifying the cause. The history should be thorough and include the patient’s present symptoms, past medical history, family and social history as well as any history of transfusion, drug/chemical/radiation exposure or recent travel to areas that are endemic to certain infections.

Symptoms of thrombocytopenia are mainly specific to the underlying cause of the condition. Many patients may even be asymptomatic. However, common findings among symptomatic patients include the ones related to bleeding (eg, blood in stool, easy bruising, nosebleeds, abnormal menstruation, etc.) and weakness or fatigue.

A thorough history is essential to an effective evaluation of thrombocytopenia. While some of the conditions leading to thrombocytopenia can be immediately diagnosed, others may require specific or repeated questioning. In addition to a well-investigated present illness, a precise past medical history can help a great deal to identify the cause of thrombocytopenia. The history should include questions about:^[1][2][3]

• Bleeding (eg, petechiae, ecchymoses, epistaxis, gingival bleeding, hematemesis, melena, menorrhagia)
• Other symptpms such as fever, rashes, pain (eg, in bone), headache, or vision changes
• Recent travel (dengue fever, malaria, rickettsial infections, tick bite, leptospirosis, meningococcemia, Hantavirus, Ebola, Lassa fever
• Recent hospitalizations/ immunizations
• Any previous illnesses (esp. hematologic and rheumatologic) and recent infections, malignancies (eg, myelodysplastic syndrome, leukemia, lymphoma, aplastic anemia)
• Pregnancy
• Transfusions
• Organ transplant
• Medications (aspirin, NSAIDs, heparin, LMWH, etc.)/ herbs/ chemicals/ radiation
• Family history of bleeding disorders and/or thrombocytopenia. (Note: Negative family history does not rule out the possibility of genetic etiologies because some individuals with familial platelet disorders remain undiagnosed well into adulthood.)
• Dietary habits (eg, vegetarianism)
• High-risk behaviors (HIV, hepatitis)
• Alcohol/ drug use

Thrombocytopenia usually has no symptoms and is picked up on a routine full blood count (or complete blood count). Symptomatic patients may experience:^[1]

• Easy bruising
• Bleeding symptoms (eg, those indicative of petechiae, purpura, ecchymoses, epistaxis, gingival bleeding, hematemesis, melena, menorrhagia)
• Malaise, fatigue and general weakness

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