TABLE 38.

5 Differential Diagnosis of Thrombocytopenia in Children

I. Destructive Thrombocytopenias
Primary platelet Idiopathic thrombocytopenia purpura
consumption syndromes Drug–induced thrombocytopenia
Infection-induced thrombocytopenia (human
Immunologic immunodeficiency
Posttransfusion virus)
purpura
Autoimmune or lymphoproliferative disorders
Neonatal immune thrombocytopenias
Allergy and anaphylaxis
Posttransplantation thrombocytopenia
Chronic microangiopathic hemolytic anemia
and thrombocytopenia
Nonimmunologic Thrombotic thrombocytopenic purpura
Hemolytic uremic syndrome
Catheters, prostheses, or cardiopulmonary
bypass
Congenital or acquired heart disease
Combined platelet and Disseminated intravascular coagulation
fibrinogen consumption Kasabach–Merritt syndrome
Miscellaneous
syndromes causes Other causes of local consumption
Phototherapy
coagulopathy
Perinatal aspiration syndromes
Persistent pulmonary hypertension
Rhesus alloimmunization
II. Impaired or Ineffective Production
Congenital and hereditary TAR syndrome
disorders Other congenital thrombocytopenias with
megakaryocytic hypoplasia
Fanconi aplastic anemia
Primary hematologic May–Hegglin anomaly*
Bernard–Soulier syndrome*
processes Wiskott–Aldrich syndrome*
Miscellaneous hereditary thrombocytopenias
(X-linked or autosomal)*
Mediterranean thrombocytopenia
Metabolic inborn errors Holocarboxylase synthetase deficiency
Associated with trisomy 13 or 18
Isovaleric acidemia
Some mitochondrial disorders
Methylmalonic acidemia
Ketotic glycinemia
Acquired disorders Aplastic anemia
Marrow infiltrative processes
Drug or radiation induced
Nutritional deficiency states (iron, folate, or
vitamin B12)
III. Sequestration
Hypersplenism
Hypothermia

Specific to the neonate Status post exchange transfusion

Polycythemia

Metabolic inborn errors of metabolism

Maternal HELLP syndrome
*These hereditary thrombocytopenias can be associated with normal or increased bone marrow megakaryocytes.
Glomerular
HELLP, hypertension, elevated disease low platelets; TAR, thrombocytopenia–absent radius.
liver enzymes,
Preeclampsia
Modified from Schultz Beardsley D. Platelet abnormalities in infancy and childhood. In: Nathan DG, Oski FA, eds. Hematology of Infancy and
th ed. Philadelphia: WB Saunders; 1993;2:1566.