A 45 Year old Woman Presents With Thrombocytopenia

A 45-year-old woman presents to your office with petechiae noted on the lower extremities. A platelet count is obtained and noted to be 10,000. Which of the following conditions would not be associated with her thrombocytopenia

A) Epistaxis
B) Hemarthrosis
C) Vaginal bleeding
D) Mucosal bleeding in the mouth
E) Ecchymosis at the site of minor trauma

Answer And Discussion:
The Answer Is B (Hemarthrosis)

Thrombocytopenia is caused by decreased platelet production, splenic sequestration of platelets, increased platelet destruction or use, or dilution of platelets.
Severe thrombocytopenia results in a characteristic pattern of bleeding:

• multiple petechiae in the skin, often most evident on the lower legs; 
• scattered small ecchymoses at sites of minor trauma; 
• mucosal bleeding (epistaxis, bleeding in the GI and genitourinary [GU] tracts, vaginal bleeding); and 
• excessive bleeding following surgical procedures. 

Heavy GI bleeding and bleeding into the central nervous system (CNS) may be life threatening.

Thrombocytopenia does not cause massive bleeding into tissues (e.g., deep visceral hematomas, hemarthroses), which is characteristic of bleeding secondary to coagulation disorders such as hemophilia.

Medications associated with thrombocytopenia include

• heparin (up to 5%, even with very low doses), 
• quinidine, 
• quinine, 
• sulfa preparations,
• oral antidiabetic drugs, 
• gold salts, and 
• rifampin