Thrombocytopenia. Diagnostic Aspects

Thrombocytopenia is a common clinical problem with many possible causes, including decreased platelet production in the bone marrow, increased peripheral destruction, sequestration in the spleen, hemodilution, and even pseudothrombocytopenia. Decreased platelet production (productive thrombocytopenia), due to megakaryocyte depression, is usually associated with hematopoietic aplasia, various forms of neoplasia, and myelotoxic therapy. Increased platelet destruction (the most common cause of thrombocytopenia) can be induced by allo- and/or autoantibodies that bind to platelets and stimulate their rapid destruction by the mononuclear phagocyte system (MPS) of the spleen or liver. Diagnosis of thrombocytopenia requires an extensive diagnostic search, i.e. taking into account the patient's anamnestic data (his background diseases and previous drug therapy), an objective physical examination, a complete blood count with a detailed study of the morphology of cellular elements in a peripheral blood smear, analysis of the megakaryocytic apparatus in bone marrow samples (in certain cases), additional specialized laboratory and instrumental tests. This review article aims to summarize the most common and/or life-threatening causes of thrombocytopenia and review the diagnostic criteria for this pathology according to international guidelines.