THROMBOCYTOPENIA

The mnemonic VINDICATE is very useful to develop a list of causes of thrombocytopenia. V—Vascular disorders should help the recall of disseminated intravascular coagulation (DIC). I—Inflammation. Infectious diseases that may be associated with thrombocytopenia include malaria, rickettsia, toxic shock syndrome, typhoid fever, cytomegalovirus (CMV), and septicemia. N—Neoplasms that may be associated with thrombocytopenia include leukemia, lymphoma, and myeloma; however, any tumor that may invade the bone marrow can cause thrombocytopenia. D—Deficiency disorders include vitamin B₁₂ and folic acid deficiencies. I—Intoxication. This category will prompt the recall of thrombocytopenia associated with gold salts, alcohol, chemotherapy, chloramphenicol, phenylbutazone, radiation, thiazides, sulfonamides, and quinidine. C—Congenital. This category promotes the recall of Wiskott–Aldrich syndrome, Fanconi anemia, maternal drug ingestion, and congenital viral infections. A—Autoimmune. The most important disorders brought to mind by this category are idiopathic autoimmune thrombocytopenia purpura and collagen diseases. T—Trauma. Although trauma does not directly induce thrombocytopenia, this category should help to recall transfusion reactions and DIC. E—Endocrine. This category prompts the recall of hyperthyroidism and thyroiditis.

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TINNITUS AND DEAFNESS

	V	I	N	D
	Vascular	Inflammatory	Neoplasm	Degenerative
External Canal		Otitis externa	Papilloma
Middle Ear		Otitis media		Otosclerosis
Inner Ear	Spasm of internal auditory artery (migraine)	Petrositis Labyrinthitis or cochleitis	Cholesteatoma	Senile deafness Ménière disease
Acoustic Nerve	Aneurysm		Acoustic neuroma
Brainstem	Basilar artery insufficiency and occlusion	Syphilis Viral encephalitis	Glioma Meningioma	Syringomyelia

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Approach to the Diagnosis

The laboratory workup will provide the best means of diagnosing the cause of thrombocytopenia. If there is pancytopenia, the most likely cause is aplastic anemia or bone marrow invasion. Collagen disorders such as lupus erythematosus would paint a similar picture. If only the platelets are affected, autoimmune disorders would be more likely the cause. The initial workup should include a CBC, blood smear for morphology, sedimentation rate, serum B₁₂ and folic acid levels, chemistry panel, ANA, serum haptoglobins, red cell survival, and protein electrophoresis. A hematologist should be consulted.

Other Useful Tests

1. Bone marrow examination (aplastic anemia)
2. Liver–spleen scan (splenomegaly, disease of the spleen)
3. CT scan of the abdomen (neoplasm, Hodgkin lymphoma, splenomegaly)
4. Bone scan (metastasis)
5. Platelet antibody titer (thrombocytopenia)

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Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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