Thrombocytopenias: A clinical point of view

The finding of thrombocytopenia may sometimes be a warning sign of high-risk situations requiring swift therapeutic decisions. The diagnosis must start with the patient’s history and data, with a careful evaluation of all blood counts and confirmation of the thrombocytopenia, followed by a morphological evaluation of the peripheral blood smear which, together with objective clinical findings, such as bleeding, lymphadenopathy and splenomegaly, will indicate the need for immediate therapy or appropriate further diagnostic investigations. Thrombocytopenia occurring in surgical patients can basically be attributed to DIC or HIT: the differential diagnosis is made on the basis of the correct laboratory investigations. In our opinion, the possibility of an ongoing pregnancy should always be evaluated in thrombocytopenic women of childbearing age, since a confirmed pregnancy implies that clinical forms of strictly obstetric pertinence are also possible. In conclusion, the overall picture of thrombocytopenias is extremely variegated, leading to numerous diagnostic and therapeutic problems whose solutions require close collaboration between clinicians and laboratory specialists.