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Chapter: Paediatrics: Haematology

Paediatrics: Thrombocytopenia

Selective megakaryocyte depression: viral (HIV, parvovirus, EBV) or more substantial bacterial infection, drugs, and poisons.

Thrombocytopenia

 

Defined as <150 × 109/L: as platelet count decreases risk of bleeding and bruising increases. Risk of bleeding is moderately high <20 × 109/L and likely if <10 × 109/L.

 

Causes

 

Decreased platelet production

 

·  Selective megakaryocyte depression: viral (HIV, parvovirus, EBV) or more substantial bacterial infection, drugs, and poisons.

·  Marrow failure: aplastic anaemia, Fanconi’s syndrome, severe IUGR, severe maternal pre-eclampsia, neonatal sepsis.

·  Marrow infiltration: leukaemia, neuroblastoma, osteopetrosis.

·  Marrow depression: radiotherapy, cytotoxic drugs, drug reaction.

·  Hereditary: Wiskott–Aldrich syndrome (X-linked recessive: boys present with early thrombocytopenia, eczema, and immunocompromise due to immunoglobulin abnormalities), BSS, TAR syndrome.

·  Nutritional deficiency: vitamin B12 or folate deficiency.

 

Increased destruction

 

·  Immune: ITP (most commonly in child, rarely in mother), neonatal alloimmune thrombocytopenia (NAIT), SLE, drug-induced (penicillin or heparin-induced thrombocytopenia (HIT)), infection (e.g. malaria or HIV).

·  Non-immune: DIC, giant haemangioma (Kasabach–Merritt syndrome), HUS, cardiac disease (prosthetic valves or cardiopulmonary bypass).

·  Hypersplenism: platelets pool in enlarged spleen from whatever cause—effect is dilutional, rather than destructive.

 

Investigations

 

·  History: drug history, family history, preceding viral illness.

 

·  Examination: signs of bleeding, lymphadenopathy, hepatosplenomegaly, concurrent infection.

 

·  FBC and blood film.

 

·  Serology: anti-platelet antibodies (e.g. anti-HPA1) if NAIT suspected, autoimmune antibodies in those with chronic ITP, viral serology (CMV, EBV along with monospot if infectious mononucelosis suspected, or HIV if unusual unexplained thrombocytopenia).

 

·  Bone marrow aspirate and trephine: very rarely required in cases of unexplained thrombocytopenia.

 

·  Cranial CT scan: if any evidence of possible intracerebral haemorrhage.

 

Treatment

 

·  Treat underlying cause if possible.

 

·  Platelet transfusion if very low platelet count (prophylactically, and guided by haematologists, except for ITP) or life-threatening bleeding.

 

·  Splenectomy, e.g chronic ITP, hypersplenism.

 

Bone marrow transplant may be helpful in some inherited bone marrow failure syndromes.

 

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Paediatrics: Haematology : Paediatrics: Thrombocytopenia |


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