Nishant Rajendra Tiwari: My 12-Step Thrombocytopenia Workup
Nishant Rajendra Tiwari, HemOnc Fellow at OU Health, shared a post on X:
“My 12-Step Thrombocytopenia Workup
(Not Medical Advice)
1. Review baseline counts first. Rule out pseudothrombocytopenia.
2. Evaluate for critical conditions: TTP, HIT, or DIC?
- Assess heparin exposure – Calculate 4T score.
- Peripheral smear for schistocytes.
- Check LDH/Haptoglobin/Bilirubin, PT/aPTT/Fibrinogen.
3. Assess for acute leukemia or bone marrow involvement?
- Examine peripheral smear for abnormal/neoplastic cells.
- Consider imaging if clinically indicated.
- Do we need a bone marrow exam?
4. Active life-threatening bleeding? Do we need a platelet transfusion?
5. Review drug-induced thrombocytopenia. Always consult latest literature for implicated medications.
6. Investigate secondary causes:
- Nutritional deficiencies: B12, Folate, Copper, Zinc.
- Infections: HIV, Hepatitis, CMV, EBV, HSV (clinically guided).
- Sepsis leading to DIC.
- Endocrine disorders: TSH, Free T4.
7. Review imaging for cirrhosis/splenomegaly. If inconclusive, obtain abdominal ultrasound.
8. Consider mechanical causes: Dialysis/ECMO/IABP/cardiopulmonary bypass/artificial heart valve?
9. Evaluate pregnancy-related disorders: HELLP, AFLP, gestational thrombocytopenia.
10. Assess for autoimmune conditions if clinically warranted. Consider SLE and other rheumatological diseases.
11. Consider rare but serious differentials:
- CAPS, other TMA causes, PNH
- Post-transfusion purpura, HLH
- Pursue only with appropriate clinical suspicion
12. If no clear etiology identified, consider ITP as diagnosis of exclusion.
Key Clinical Considerations:
- Critically ill patients frequently have multifactorial thrombocytopenia [A combination of some of the above].
- Primary HLH presenting de novo in adults is exceedingly rare.
- Thrombocytopenia with thrombosis: Consider DIC, TTP, HIT, PNH, or VITT.
[Image AI Generated] ”
Stay informed with Hemostasis Today.
-
Jun 1, 2026, 18:51Francesco Giurazza: New Publication on Glubran-2 in Acute Bleeding Patients with Coagulopathies
-
Jun 1, 2026, 18:50Donald Arnold is the Recipient of the Roberts Award – ISTH
-
Jun 1, 2026, 18:49Amirreza Jabbaripour Sarmadian: My First Paper as Corresponding Author on Upper Extremity DVT Following COVID-19 Vaccination
-
Jun 1, 2026, 18:49James P. Crowley: How Combining Vitamin D analogs with Chemotherapy Impacts Survival Outcomes
-
Jun 1, 2026, 18:42Debojyoti Chakraborty: Small But Meaningful Steps Toward A Gene Editing Trial For Sickle Cell Disease In India
-
Jun 1, 2026, 17:14Tiffany Gacel: What an Incredible Day With NBCA and The Red Bus Tour at Memorial at Gulfport?
-
Jun 1, 2026, 17:12Marie-Claire Kofi: Poster Highlights the Process of Establishing the Sickle Cell Transitions Policy Lab
-
Jun 1, 2026, 17:00Azusa Nagao: Organizing the Symposium on Women and Bleeding Disorders at JSTH Annual Meeting
-
Jun 1, 2026, 16:57Kuljeet Kaur: Approach to Anemia – More Than Just a Low Hemoglobin