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Heghine Khachatryan: Approaching Thrombocytopenia Through Mechanism and Clinical Context

Heghine Khachatryan/LinkedIn

Oct 26, 2026, 15:13

Heghine Khachatryan: Approaching Thrombocytopenia Through Mechanism and Clinical Context

Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn about a recent article by Roberto Stasi, published in Hematology, ASH Education Program, adding:

“Approaching Thrombocytopenia Through Mechanism and Clinical Context

Revisiting Roberto Stasi’s How to approach thrombocytopenia, published in the ASH Education Program in 2012, highlights the value of a structured diagnostic approach.

The review describes four broad mechanisms: decreased platelet production, increased destruction or consumption, splenic sequestration, and hemodilution. Multiple mechanisms may contribute simultaneously, particularly in critically ill patients.

Four clinical priorities deserve emphasis:

• Establish the context. Platelet trajectory, medication exposure, associated cytopenias, pregnancy, and systemic illness shape the differential diagnosis.

• Examine the peripheral blood smear. Platelet clumping, schistocytes, blasts, and abnormalities across other cell lineages can substantially redirect the investigation.

• Recognize urgent conditions. Thrombotic microangiopathies, heparin-induced thrombocytopenia, and disseminated intravascular coagulation require prompt recognition. The absence of prominent bleeding does not exclude a dangerous underlying process.

• Establish ITP through careful exclusion of alternative causes. Subsequent international consensus also supports omitting routine initial bone marrow examination when thrombocytopenia is isolated and clinical examination and blood-film findings show no atypical features.

My assessment is that the article’s principal strength lies in integrating pathophysiology, morphology, and clinical setting into practical diagnostic reasoning.

Its limitations are its narrative design and publication date: it provides an educational framework, while contemporary management decisions require current disease-specific evidence and guidance.

For clinical education, this remains a valuable reminder to connect the platelet count with the patient’s evolving clinical picture – and to reassess the working diagnosis when the course becomes atypical.

Which finding most often changes your initial diagnostic impression when evaluating thrombocytopenia?”

Title: How to approach thrombocytopenia

Authors: Roberto Stasi

Heghine Khachatryan: Approaching Thrombocytopenia Through Mechanism and Clinical Context