History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors are women of childbearing age, and males and females <10 or >65 years old.
bleeding
Signs of bleeding (e.g., bruising, petechiae, haemorrhagic bullae) can be variable in Immune thrombocytopenia.
Petechiae are small red or purple spots (around 1-5 mm in diameter) on the skin or mucosal membranes that indicate small capillary haemorrhages. They can appear anywhere on the body, particularly if thrombocytopenia is severe, but are most often found on the lower limbs.
Haemorrhagic bullae 3-5 mm in diameter on the mucosal surface of the oral cavity and tongue often co-exist.
Minor mucocutaneous bleeding (e.g., bleeding gum) is common, but severe life-threatening bleeding is rare, especially in children.[22]
Large spontaneous bruising may appear on the arms and legs. Severe disease may be associated with bruising on the torso.
It is important to differentiate between the mucocutaneous bleeding of thrombocytopenia and the delayed visceral bleeding characteristic of coagulation disorders.
A history of prior bleeding points to alternative diagnoses.
absence of systemic symptoms
Specifically, address weight loss, fever, and symptoms of autoimmune disorders such as arthralgias, skin rash, alopecia, and venous thrombosis.
These symptoms should prompt work-up for other pathologies.
absence of medicines that cause thrombocytopenia
Immune thrombocytopenia is a diagnosis of exclusion. The use of heparin, alcohol, quinine/quinidine, sulfa drugs, and many other drugs may cause drug-induced thrombocytopenia.
absent splenomegaly or hepatomegaly
Less than 3% of patients with Immune thrombocytopenia have splenomegaly. This is similar to the percentage of normal people with a palpable spleen.
absent lymphadenopathy
Lymphadenopathy should prompt the work-up for lymphoproliferative, autoimmune, or infectious aetiologies.
Risk factors
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