Platelet clumping due to activation during collection

Review peripheral smear.

2. Undercounting of macrothrombocytes. Review peripheral smear and check platelet size.

TABLE I-26. DIFFERENTIAL DIAGNOSIS OF THROMBOCYTOPENIA DURING CHILDHOOD

Decreased Production

Increased Destruction

Sequestration

Hereditary disorders:

Immune-Mediated:

Sequesratlon:

Hereditary thrombocy

ITP

Hypersplenism

topenia

Autoimmune (SLE)

Hypothermia

TAR syndrome

HIV

Burns

Wiskott-Aldrich syndrome

Neonatal immune reaction

Portal hypertension

May-Hegglin anomaly

Drugs

Gaucher disease

Allergy and anaphylaxis

Post-transplant or

post-transfusion

Acquired Disorders:

Nonimmune:

Aplastic anemia

Infection

Infection

Microangiopathic (HUS,

Marrow infiltration or

ITP, drugs)

damage (malignancy)

Congenital heart disease

Drugs

Kasabach-Merritt syndrome

AIDS = acquired immunodeficiency syndrome; HIV = human immunodeficiency syndrome; HUS = hemolytic uremic syndrome; ITP = idiopathic thrombocytopenic purpura; SLE = systemic lupus erythematosus; TAR = thrombocytopenia with absent radii.

AIDS = acquired immunodeficiency syndrome; HIV = human immunodeficiency syndrome; HUS = hemolytic uremic syndrome; ITP = idiopathic thrombocytopenic purpura; SLE = systemic lupus erythematosus; TAR = thrombocytopenia with absent radii.

3. Pseudothrombocytopenia due to EDTA-dependent antibodies, cold agglutinins, or drugs. For ethylenediamine tetra-acetic acid (EDTA)-related problems, recheck platelet counts with alternative anticoagulants (eg, heparin). B. Destructive Thrombocytopenia 1. Immune thrombocytopenia a. Acute and chronic ITP. Caused by antiplatelet antibodies. Chronic ITP is defined as lasting longer than 6 months.

b. Autoimmune diseases with thrombocytopenia as a manifestation. Immune thrombocytopenia associated with cancer, systemic lupus erythematosus (SLE), Evans syndrome, antiphospholipid antibody syndrome, cyclic thrombocytopenia (variant of chronic ITP), autoimmune lym-phoproliferative syndrome.

c. HIV-associated thrombocytopenia.

d. Neonatal immune thrombocytopenia i. Alloimmune. Usually due to incompatibility for alloanti-gen HPA-1a (PLA1 or ZWa).

ii. Autoimmune. In infants of mothers with immune thrombocytopenia related to, for example, ITP or SLE.

e. Drug-induced immune thrombocytopenia (heparin, gold salts, levodopa, interferon-a, procainamide).

f. Allergy and anaphylaxis.

g. Post-transplantation.

h. Post-transfusion purpura.

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