Etiologies of Thrombocytopenia in the Community Hospital: The Experience of 1 Hematologist.

Background: Thrombocytopenia in hospitalized patients is a common cause for hematologic consultation. Our experience in the community hospital setting can inform treating physicians of the causes for and need to treat thrombocytopenia. Here we describe our clinical experience from 2 community hospitals over a 22-month period, wherein a single hematologist was consulted for 97 cases of thrombocytopenia in 93 patients.

Methods: Referred patients underwent history, physical, review of old records and imaging, relevant laboratory testing, review of the peripheral smear, and a bone marrow aspirate and biopsy if clinically indicated.

Results: Thirty-five patients had a primary hematologic cause for their thrombocytopenia. Fifty-one had secondary causes for thrombocytopenia. Eleven patients had no discernible etiology for their thrombocytopenia. The most common hematologic diagnoses were immune thrombocytopenia purpura (n = 12), heparin-induced thrombocytopenia (n = 6), in vitro platelet clumping (n = 4), quite remarkably acute progranulocytic leukemia (n = 4), and thrombotic thrombocytopenia purpura (n = 3). The latter 3 were immediately diagnosed by reviewing the peripheral smear, which led to appropriate therapy. The most common nonhematologic etiologies were liver disease (n = 21), bacterial sepsis (n = 12), and oral medication (n = 7). Although the thrombocytopenia was mostly nonacute, immediate hematologic interventions were needed for 21 patients. Four patients died, none from complications of thrombocytopenia.

Conclusions: Thrombocytopenia in hospitalized patients requires consideration of multiple etiologies and review of the peripheral smear. Liver disease is often overlooked as a cause for thrombocytopenia.