Key messages

• A low platelet count should be confirmed by a repeat sample. A blood film should be requested and a screen performed for clotting abnormalities and fibrin degradation products (or equivalent).

• The patient's history, including the drug history (particularly heparin), should be checked. Any medications causally implicated or worsening platelet function (e.g. aspirin) should be discontinued.

• Hemorrhage and any features of disease should be sought and further tests performed as appropriate (e.g. autoimmune screen, bone marrow).

• Advice should be sought from a hematologist.

• Platelet concentrates should be used in life-threatening hemorrhage. Otherwise, they may not be appropriate (e.g. in thrombotic thrombocytopenic purpura).

• The platelet count should be maintained above 15 * 10 9/l. A higher threshold should be set if the patient is unstable. To cover invasive procedures the platelet count should be elevated to 30 to 50 * 109/l.

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