Nishant Rajendra Tiwari – My 12-Step Thrombocytopenia Workup
Nishant Rajendra Tiwari, Hematology-Oncology Fellow at OU Health Stephenson Cancer Center, posted 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.
-
Sep 11, 2026, 17:41Khaled Musallam: Earlier Recognition, Better Outcomes in NTDT
-
Sep 11, 2026, 17:29Reyhan Kose Cobanoglu: APS ACTION Registry Study Published in Lupus
-
Sep 11, 2026, 17:14Obi Light Ogbonnia: From Kenya to Global Sickle Cell Advocacy
-
Sep 11, 2026, 17:01EAHAD 2027 Marks 20 Years
-
Sep 11, 2026, 16:54Denise Braendgaard: Reimagining Health Systems Through Collective Action
-
Sep 11, 2026, 16:47Jehad Khamaysa: Budd-Chiari Syndrome as the Initial Presentation of Behçet’s Disease in a 16-Year-Old
-
Sep 11, 2026, 16:44Mostafa Faisal Mohammed Saleh: From HLA Biology to Curative Therapy
-
Sep 11, 2026, 16:38Jim Kaveney: Class I, Level A – Lifestyle is Now the Official Standard in AFib Care
-
Sep 11, 2026, 16:31George Touma: Do We Really Need to Implant Metal in Every High-Bleeding-Risk Patient?