thrombocytopenia

File:Petechia lower leg2.jpg

File:Trombocitopenia 01.JPG]]

Thrombocytopenia usually has no symptoms and is picked up on a routine complete blood count. Some individuals with thrombocytopenia may experience external bleeding, such as nosebleeds or bleeding gums. Some women may have heavier or longer periods or breakthrough bleeding. Bruising, particularly purpura in the forearms and petechiae in the feet, legs, and mucous membranes, may be caused by spontaneous bleeding under the skin.{{Cite web |title=B.E. Project on Platlet Count Using Image Processing Techniques |url=http://cs.nyu.edu/~sg4187/Platelet.pdf |url-status=live |archive-url=https://web.archive.org/web/20160910153440/http://cs.nyu.edu/~sg4187/Platelet.pdf |archive-date=10 September 2016 |access-date=30 November 2014 |website=BTP_Report |vauthors=Bhatia MP}}{{Cite book |url=https://books.google.com/books?id=IXynWiryyjoC&q=thrombocytopenia+symptoms+signs&pg=PA294 |title=Chamberlain's Symptoms and Signs in Clinical Medicine 13th Edition, An Introduction to Medical Diagnosis |vauthors=Houghton AR, Gray D |publisher=CRC Press |year=2010 |isbn=9780340974254 |access-date=2015-05-01 |archive-url=https://web.archive.org/web/20230111145413/https://books.google.com/books?id=IXynWiryyjoC&q=thrombocytopenia+symptoms+signs&pg=PA294 |archive-date=2023-01-11 |url-status=live}}

Eliciting a full medical history is vital to ensure the low platelet count is not secondary to another disorder. Ensuring that the other blood cell types, such as red blood cells and white blood cells, are not also suppressed, is also important.

Painless, round, and pinpoint (1 to 3 mm in diameter) petechiae usually appear and fade, and sometimes group to form ecchymoses. Larger than petechiae, ecchymoses are purple, blue, or yellow-green areas of skin that vary in size and shape. They can occur anywhere on the body.

A person with this disease may also complain of malaise, fatigue, and general weakness (with or without accompanying blood loss). Acquired thrombocytopenia may be associated with the use of certain drugs. Inspection typically reveals evidence of bleeding (petechiae or ecchymoses), along with slow, continuous bleeding from any injuries or wounds. Adults may have large, blood-filled bullae in the mouth.{{Cite book |url=https://books.google.com/books?id=PcARTQwHLpIC&pg=PA293 |title=Interpreting Signs and Symptoms |publisher=Lippincott Williams & Wilkins |year=2007 |isbn=9781582556680 |page=293}} If the person's platelet count is between 30,000 and 50,000/μL, bruising with minor trauma may be expected; if it is between 15,000 and 30,000/μL, spontaneous bruising will be seen (mostly on the arms and legs).{{Cite book |url=https://books.google.com/books?id=odY9mXicPlYC&q=thrombocytopenia++signs+fatigue&pg=PA1256 |title=Textbook of Basic Nursing |vauthors=Rosdahl CB, Kowalski MT |publisher=Lippincott Williams & Wilkins |year=2008 |isbn=9780781765213 |access-date=2015-05-01 |archive-url=https://web.archive.org/web/20230111145434/https://books.google.com/books?id=odY9mXicPlYC&q=thrombocytopenia++signs+fatigue&pg=PA1256 |archive-date=2023-01-11 |url-status=live}}

Thrombocytopenia can be inherited or acquired.{{Cite web |title=What Causes Thrombocytopenia? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/causes |url-status=live |archive-url=https://web.archive.org/web/20141202192645/http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/causes |archive-date=2 December 2014 |access-date=4 December 2014 |website=National Heart, Lung, and Blood Institute (NHLBI) |publisher=U.S. Department of Health and Human Services}}

Abnormally low platelet production may be caused by:{{Cite book |url=https://books.google.com/books?id=UGVylX6g4i8C&q=thrombocytopenia+decreased+production&pg=PA841 |title=Principles of Ambulatory Medicine |vauthors=Fiebach NH, Barker LR, Burton JR, Zieve PD |publisher=Lippincott Williams & Wilkins |year=2007 |isbn=9780781762274 |access-date=2015-04-30}}

• Dehydration, vitamin B₁₂ or folic acid deficiency
• Leukemia, myelodysplastic syndrome, or aplastic anemia
• Decreased production of thrombopoietin by the liver in liver failure
• Sepsis, systemic viral or bacterial infection
• Leptospirosis
• Hereditary syndromesAlmazni I, Stapley R, Morgan NV (2019) Inherited Thrombocytopenia: Update on genes and genetic variants which may be associated With bleeding. Front Cardiovasc Med
• ACTN1-related thrombocytopenia
• Amegakaryocytic thrombocytopenia with radio-ulnar synostosis
• ANKRD26 related thrombocytopenia
• Autosomal dominant thrombocytopenia
• Bernard–Soulier syndrome (associated with giant platelet disorder)
• Congenital amegakaryocytic thrombocytopenia
• Congenital amegakaryocytic thrombocytopenia and radioulnar synostosis
• CYCS-related thrombocytopenia
• Epstein syndrome (associated with giant platelet disorder)
• ETV6 related thrombocytopenia
• Fanconi anemia
• Filaminopathies A
• FYB related thrombocytopenia
• Glanzmann's thrombasthenia
• GNE myopathy with congenital thrombocytopenia
• Gray platelet syndrome (associated with giant platelet disorder)
• Harris platelet syndrome (associated with giant platelet disorder)
• Macrothrombocytopenia and hearing loss
• May–Hegglin anomaly (associated with giant platelet disorder)
• MYH9-related disease (associated with giant platelet disorder)
• PRKACG-related thrombocytopenia
• Paris-Trousseau thrombocytopenia/Jacobsen syndrome
• Sebastian syndrome
• SLFN14-related thrombocytopenia
• Stormorken syndrome
• TRPM7-related thrombocytopenia
• Thrombocytopenia absent radius syndrome
• Tropomyosin 4-related thrombocytopenia
• TUBB1-related thrombocytopenia
• Upshaw–Schulman syndrome
• Wiskott–Aldrich syndrome
• X-linked thrombocytopenia
• X-linked thrombocytopenia with thalassemia

File:Thrombi in patient with thrombotic thrombocytopenic purpura .jpg

Abnormally high rates of platelet destruction may be due to immune or nonimmune conditions, including:{{Cite book |url=https://books.google.com/books?id=-tHsAwAAQBAJ&q=thrombocytopenia+decreased+production&pg=PA695 |title=Hematology: Clinical Principles and Applications |vauthors=Rodak BF, Fritsma GA, Keohane E |publisher=Elsevier Health Sciences |year=2013 |isbn=9780323292696 |access-date=2015-04-30 |archive-url=https://web.archive.org/web/20230111145413/https://books.google.com/books?id=-tHsAwAAQBAJ&q=thrombocytopenia+decreased+production&pg=PA695 |archive-date=2023-01-11 |url-status=live}}

• Immune thrombocytopenic purpura
• Thrombotic thrombocytopenic purpura
• Hemolytic–uremic syndrome
• Disseminated intravascular coagulation
• Paroxysmal nocturnal hemoglobinuria
• Antiphospholipid syndrome
• Systemic lupus erythematosus
• Post-transfusion purpura
• Neonatal alloimmune thrombocytopenia
• Hypersplenism
• Dengue fever
• Gaucher's disease
• Zika virus

These medications can induce thrombocytopenia through direct myelosuppression:{{Cite book |url=https://books.google.com/books?id=kB4C84kCDZEC&q=thrombocytopenia+medication+induced&pg=PA168 |title=Platelets in Hematologic and Cardiovascular Disorders: A Clinical Handbook |vauthors=Gresele P, Fuster V, Lopez JA, Page CP, Vermylen J |publisher=Cambridge University Press |year=2007 |isbn=9781139468763 |access-date=2015-04-30}}

• Valproic acid
• Methotrexate
• Carboplatin
• Interferon
• Isotretinoin
• Panobinostat
• H₂ blockers and proton-pump inhibitors

• Laboratory error, possibly due to the anticoagulant EDTA in CBC specimen tubes; a citrated platelet count is a useful follow-up study{{Cite journal |vauthors=Tan GC, Stalling M, Dennis G, Nunez M, Kahwash SB |date=2016 |title=Pseudothrombocytopenia due to Platelet Clumping: A Case Report and Brief Review of the Literature |journal=Case Reports in Hematology |volume=2016 |pages=3036476 |doi=10.1155/2016/3036476 |pmc=5164902 |pmid=28044112 |doi-access=free}}{{additional citation needed|date=October 2023}}
• Snakebite{{Cite book |url=https://books.google.com/books?id=eLqMpXfAlEcC&q=thrombocytopenia++snake+bites&pg=PA388 |title=Oxford Desk Reference: Critical Care |vauthors=Waldmann C, Soni N, Rhodes A |publisher=Oxford University Press |year=2008 |isbn=9780199229581 |access-date=2015-05-01 |archive-url=https://web.archive.org/web/20230111145414/https://books.google.com/books?id=eLqMpXfAlEcC&q=thrombocytopenia++snake+bites&pg=PA388 |archive-date=2023-01-11 |url-status=live}}
• Lyme disease{{Cite book |url=https://books.google.com/books?id=NYCeAgAAQBAJ&q=thrombocytopenia+lyme+disease&pg=PA1103 |title=Wintrobe's Clinical Hematology |vauthors=Greer JP, Arber DA, Glader B, List AF, Means RT, Paraskevas F, Rodgers GM |publisher=Lippincott Williams & Wilkins |year=2013 |isbn=9781469846224 |access-date=2015-05-01 |archive-url=https://web.archive.org/web/20230111145416/https://books.google.com/books?id=NYCeAgAAQBAJ&q=thrombocytopenia+lyme+disease&pg=PA1103 |archive-date=2023-01-11 |url-status=live}}
• Thrombocytapheresis (also called plateletpheresis){{citation needed|date=May 2018}}
• Niemann–Pick disease{{Cite web |title=Niemann-Pick disease |url=https://ghr.nlm.nih.gov/condition/niemann-pick-disease#inheritance |url-status=live |archive-url=https://web.archive.org/web/20180924094059/https://ghr.nlm.nih.gov/condition/niemann-pick-disease#inheritance |archive-date=2018-09-24 |access-date=2020-06-12 |website=Genetics Home Reference |publisher=U.S. National Library of Medicine}}{{Cite web |title=Niemann-Pick - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/niemann-pick/symptoms-causes/syc-20355887 |url-status=live |archive-url=https://web.archive.org/web/20200804080238/https://www.mayoclinic.org/diseases-conditions/niemann-pick/symptoms-causes/syc-20355887 |archive-date=2020-08-04 |access-date=2020-06-12 |website=Mayo Clinic}}

Laboratory tests for thrombocytopenia might include full blood count, liver enzymes, kidney function, vitamin B₁₂ levels, folic acid levels, erythrocyte sedimentation rate, and peripheral blood smear. If the cause for the low platelet count remains unclear, a bone marrow biopsy is usually recommended to differentiate cases of decreased platelet production from cases of peripheral platelet destruction.{{Cite web |title=How Is Thrombocytopenia Diagnosed? |url=http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/diagnosis |url-status=live |archive-url=https://web.archive.org/web/20150525131551/http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/diagnosis |archive-date=2015-05-25 |access-date=2015-05-19 |website=National Heart, Lung, and Blood Institute (NHLBI) |publisher=U.S. Department of Health and Human Services}}

Thrombocytopenia in hospitalized alcoholics may be caused by spleen enlargement, folate deficiency, and most frequently, the direct toxic effect of alcohol on production, survival time, and function of platelets.{{Cite book |url=https://books.google.com/books?id=KkL0BwAAQBAJ&q=alcoholics+thrombocytopenia&pg=PA264 |title=Medical and Nutritional Complications of Alcoholism: Mechanisms and Management |vauthors=Lieber CS |publisher=Springer Science & Business Media |year=2012 |isbn=9781461533207 |language=en |access-date=2020-10-10 |archive-url=https://web.archive.org/web/20230111145418/https://books.google.com/books?id=KkL0BwAAQBAJ&q=alcoholics+thrombocytopenia&pg=PA264 |archive-date=2023-01-11 |url-status=live}} Platelet count begins to rise after 2 to 5 days' abstinence from alcohol. The condition is generally benign, and clinically significant hemorrhage is rare.{{citation needed|date=May 2017}}

In severe thrombocytopenia, a bone marrow study can determine the number, size, and maturity of the megakaryocytes. This information may identify ineffective platelet production as the cause of thrombocytopenia and rule out a malignant disease process at the same time.{{Cite book |url=https://books.google.com/books?id=cGBaz0hp_fcC&q=thrombocytopenia+++diagnosis&pg=PA489 |title=Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects |vauthors=Hillyer CD, Abrams CS, Shaz BH, Roshal M, Zimring JC, Abshire TC |publisher=Elsevier |year=2009 |isbn=9780080922300 |access-date=2015-05-01}}

Treatment is guided by the severity and specific cause of the disease. Treatment focuses on eliminating the underlying problem, whether that means discontinuing drugs suspected to cause it or treating underlying sepsis. Diagnosis and treatment of serious thrombocytopenia is usually directed by a hematologist. Corticosteroids may be used to increase platelet production. Lithium carbonate or folate may also be used to stimulate platelet production in the bone marrow.{{Cite book |url=https://books.google.com/books?id=LNapiMBi_csC&q=Thrombotic+thrombocytopenic+purpura+treatment+corticosteroids&pg=PA439 |title=Essentials of General Surgery |vauthors=Lawrence PF, Bell RM, Dayton MT |date=2012-10-31 |publisher=Lippincott Williams & Wilkins |isbn=9780781784955 |language=en |access-date=2020-10-10 |archive-url=https://web.archive.org/web/20230111145429/https://books.google.com/books?id=LNapiMBi_csC&q=Thrombotic+thrombocytopenic+purpura+treatment+corticosteroids&pg=PA439 |archive-date=2023-01-11 |url-status=live}}

Platelet transfusions may be suggested for people who have a low platelet count due to thrombocytopenia.{{Cite journal |vauthors=Estcourt LJ, Malouf R, Hopewell S, Doree C, Van Veen J |date=April 2018 |title=Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia |journal=The Cochrane Database of Systematic Reviews |volume=2018 |issue=4 |pages=CD011980 |doi=10.1002/14651858.CD011980.pub3 |pmc=5957267 |pmid=29709077 |collaboration=Cochrane Haematological Malignancies Group}}

Treatment of thrombotic thrombocytopenic purpura (TTP) is a medical emergency, since the associated hemolytic anemia and platelet activation can lead to kidney failure and changes in the level of consciousness. Treatment of TTP was revolutionized in the 1980s with the application of plasmapheresis. According to the Furlan–Tsai hypothesis,{{Cite journal |vauthors=Chapman K, Seldon M, Richards R |date=February 2012 |title=Thrombotic microangiopathies, thrombotic thrombocytopenic purpura, and ADAMTS-13 |journal=Seminars in Thrombosis and Hemostasis |volume=38 |issue=1 |pages=47–54 |doi=10.1055/s-0031-1300951 |pmid=22314603 |doi-access=free}} this treatment works by removing antibodies against the von Willebrand factor-cleaving protease ADAMTS-13. The plasmapheresis procedure also adds active ADAMTS-13 protease proteins to the patient, restoring a normal level of von Willebrand factor multimers. Patients with persistent antibodies against ADAMTS-13 do not always manifest TTP, and these antibodies alone are not sufficient to explain how plasmapheresis treats TTP.{{Cite web |title=How Is Thrombotic Thrombocytopenic Purpura Treated? |url=https://www.nhlbi.nih.gov/health/health-topics/topics/ttp/treatment |url-status=live |archive-url=https://web.archive.org/web/20150501032609/http://www.nhlbi.nih.gov/health/health-topics/topics/ttp/treatment |archive-date=2015-05-01 |access-date=2015-05-20 |website=National Heart, Lung, and Blood Institute (NHLBI) |publisher=U.S. Department of Health and Human Services}}

{{Main|Immune thrombocytopenic purpura}}

File:Oral petechiae.JPG

Many cases of immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, can be left untreated, and spontaneous remission (especially in children) is not uncommon. However, counts under 50,000/μL are usually monitored with regular blood tests, and those with counts under 10,000/μL are usually treated, as the risk of serious spontaneous bleeding is high with such low platelet counts. Any patient experiencing severe bleeding symptoms is also usually treated. The threshold for treating ITP has decreased since the 1990s; hematologists recognize that patients rarely spontaneously bleed with platelet counts greater than 10,000/μL, although exceptions to this observation have been documented.{{Cite book |url=https://books.google.com/books?id=x-RMkItgNWQC&pg=PA7 |title=Thrombocytopenic Purpura: New Insights for the Healthcare Professional: 2013 Edition: ScholarlyPaper |date=2013-07-22 |publisher=ScholarlyEditions |isbn=9781481662420 |language=en |access-date=2015-05-20 |archive-url=https://web.archive.org/web/20230111145417/https://books.google.com/books?id=x-RMkItgNWQC&pg=PA7 |archive-date=2023-01-11 |url-status=live}}{{Cite encyclopedia |title=Idiopathic thrombocytopenic purpura (ITP) |encyclopedia=MedlinePlus Medical Encyclopedia |publisher=U.S. National Library of Medicine |url=https://www.nlm.nih.gov/medlineplus/ency/article/000535.htm |access-date=2015-05-20 |archive-url=https://web.archive.org/web/20150406170820/http://www.nlm.nih.gov/medlineplus/ency/article/000535.htm |archive-date=2015-04-06 |url-status=live}}

Thrombopoetin analogues have been tested extensively for the treatment of ITP. These agents had previously shown promise, but had been found to stimulate antibodies against endogenous thrombopoietin or lead to thrombosis. Romiplostim (trade name Nplate, formerly AMG 531) was found to be safe and effective for the treatment of ITP in refractory patients, especially those who relapsed following splenectomy.{{Cite web |title=Nplate (romiplostim) for subcutaneous injection |url=https://www.fda.gov/safety/medwatch/safetyinformation/ucm182233.htm |url-status=dead |archive-url=https://web.archive.org/web/20160311074824/http://www.fda.gov/safety/medwatch/safetyinformation/ucm182233.htm |archive-date=2016-03-11 |access-date=2015-05-02 |website=www.fda.gov}}

{{main|Heparin-induced thrombocytopenia}}

Discontinuation of heparin is critical in a case of heparin-induced thrombocytopenia (HIT). Beyond that, however, clinicians generally treat to avoid thrombosis.{{Cite book |url=https://books.google.com/books?id=79OEYE4RnRQC&pg=PA1E |title=Heparin-Induced Thrombocytopenia |vauthors=Warkentin TE, Greinacher A |date=2007-07-23 |publisher=CRC Press |isbn=9781439826423 |language=en |access-date=2023-08-25 |archive-url=https://web.archive.org/web/20230111145925/https://books.google.com/books?id=79OEYE4RnRQC&pg=PA1e |archive-date=2023-01-11 |url-status=live}} Treatment may include a direct thrombin inhibitor, such as lepirudin or argatroban. Other "blood thinners" sometimes used in this setting include bivalirudin and fondaparinux. Platelet transfusions are not routinely used to treat HIT because thrombosis, not bleeding, is the primary problem.{{Cite journal |vauthors=Ahmed I, Majeed A, Powell R |date=September 2007 |title=Heparin induced thrombocytopenia: diagnosis and management update |journal=Postgraduate Medical Journal |volume=83 |issue=983 |pages=575–582 |doi=10.1136/pgmj.2007.059188 |pmc=2600013 |pmid=17823223}} Warfarin is not recommended until platelets have normalized.

Bone marrow/stem cell transplants are the only known cures for this genetic disease. Frequent platelet transfusions are required to keep the patient from bleeding to death before the transplant can be performed, although this is not always the case.{{Cite book |url=https://books.google.com/books?id=wBjr7pkmNSIC&pg=PA48 |title=Neonatology and Blood Transfusion |vauthors=Smit-Sibinga CH |date=2010-05-10 |publisher=Springer Science & Business Media |isbn=9780387236001 |language=en |access-date=2015-05-20 |archive-url=https://web.archive.org/web/20230111145946/https://books.google.com/books?id=wBjr7pkmNSIC&pg=PA48 |archive-date=2023-01-11 |url-status=live}}

Human-induced pluripotent stem cell-derived platelets is a technology currently being researched by the private sector, in association with the Biomedical Advanced Research and Development Authority and the U.S. Department of Health and Human Services, that would create platelets outside the human body.{{Cite web |date=2019-10-02 |title=New technology may aid emergency preparedness |url=https://homelandprepnews.com/stories/37483-new-technology-may-aid-emergency-preparedness/ |url-status=live |archive-url=https://web.archive.org/web/20191005173503/https://homelandprepnews.com/stories/37483-new-technology-may-aid-emergency-preparedness/ |archive-date=2019-10-05 |access-date=2019-10-23 |website=Homeland Preparedness News |vauthors=Clark D}}

Thrombocytopenia affects a few newborns, and its prevalence in neonatal intensive care units is high. Normally, it is mild and resolves without consequences. Most cases affect preterm birth infants and result from placental insufficiency and/or fetal hypoxia. Other causes, such as alloimmunity, genetics, autoimmunity, and infection, are less frequent.{{Cite journal |vauthors=Roberts I, Murray NA |date=September 2003 |title=Neonatal thrombocytopenia: causes and management |journal=Archives of Disease in Childhood. Fetal and Neonatal Edition |volume=88 |issue=5 |pages=F359–F364 |doi=10.1136/fn.88.5.F359 |pmc=1721612 |pmid=12937037}}

Thrombocytopenia that starts after the first 72 hours, since birth is often the result of underlying sepsis or necrotizing enterocolitis. In the case of infection, polymerase chain reaction tests may be useful for rapid pathogen identification and detection of antibiotic-resistance genes. Possible pathogens include viruses (e.g. cytomegalovirus, rubella virus, HIV), bacteria (e.g. Staphylococcus spp.,{{Cite journal |vauthors=Guida JD, Kunig AM, Leef KH, McKenzie SE, Paul DA |date=June 2003 |title=Platelet count and sepsis in very low birth weight neonates: is there an organism-specific response? |journal=Pediatrics |volume=111 |issue=6 Pt 1 |pages=1411–1415 |doi=10.1542/peds.111.6.1411 |pmid=12777561}} Enterococcus spp., Streptococcus agalactiae, Listeria monocytogenes, Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa,{{Cite journal |vauthors=Pacifico L, Chiesa C, Mirabella S, Panero A, Midulla M |date=March 1987 |title=Early-onset Pseudomonas aeruginosa sepsis and Yersinia enterocolitica neonatal infection: a unique combination in a preterm infant |journal=European Journal of Pediatrics |volume=146 |issue=2 |pages=192–193 |doi=10.1007/BF02343233 |pmid=3569360 |s2cid=20198866}} Yersinia enterocolitica), fungi (e.g. Candida spp.), and Toxoplasma gondii. The severity of thrombocytopenia may be correlated with pathogen type; some research indicates that the most severe cases are related to fungal or Gram-negative bacterial infection. The pathogen may be transmitted during{{Cite journal |vauthors=Rempen A, Martius J, Hartmann AA, Wecker I |year=1987 |title=Transmission rate of Ureaplasma urealyticum, Mycoplasma spp., Gardnerella vaginalis, B-streptococci, Candida spp. and Chlamydia trachomatis from the mother to the newborn |journal=Archives of Gynecology and Obstetrics |volume=241 |issue=3 |pages=165–170 |doi=10.1007/BF00931313 |pmid=3324978 |s2cid=11251976}} or before birth, by breast feeding,{{Cite journal |vauthors=Olver WJ, Bond DW, Boswell TC, Watkin SL |date=July 2000 |title=Neonatal group B streptococcal disease associated with infected breast milk |journal=Archives of Disease in Childhood. Fetal and Neonatal Edition |volume=83 |issue=1 |pages=F48–F49 |doi=10.1136/fn.83.1.F48 |pmc=1721104 |pmid=10873172}}{{Cite journal |vauthors=Kotiw M, Zhang GW, Daggard G, Reiss-Levy E, Tapsall JW, Numa A |year=2003 |title=Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission |journal=Pediatric and Developmental Pathology |volume=6 |issue=3 |pages=251–256 |doi=10.1007/s10024-001-0276-y |pmid=12687430 |s2cid=20696142}}{{Cite journal |vauthors=Gastelum DT, Dassey D, Mascola L, Yasuda LM |date=December 2005 |title=Transmission of community-associated methicillin-resistant Staphylococcus aureus from breast milk in the neonatal intensive care unit |journal=The Pediatric Infectious Disease Journal |volume=24 |issue=12 |pages=1122–1124 |doi=10.1097/01.inf.0000189983.71585.30 |pmid=16371885 |doi-access=free}} or during transfusion.{{Cite journal |vauthors=Jagielski M, Rastawicki W, Kałuzewski S, Gierczyński R |year=2007 |title=[Yersiniosis--unappreciated infectious disease] |trans-title=Yersiniosis – unappreciated infectious diseases |url=http://www.pzh.gov.pl/oldpage/przeglad_epimed/56-1/561_07.pdf |url-status=dead |journal=Przeglad Epidemiologiczny |language=pl |volume=56 |issue=1 |pages=57–64 |pmid=12150068 |archive-url=https://web.archive.org/web/20111003164323/http://www.pzh.gov.pl/oldpage/przeglad_epimed/56-1/561_07.pdf |archive-date=2011-10-03 |access-date=2011-04-10}} Interleukin-11 is being investigated as a drug for managing thrombocytopenia, especially in cases of sepsis or necrotizing enterocolitis.

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| ICD9 = {{ICD9|287.5}}

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{{Commons}}

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{{Diseases of megakaryocytes|us=y}}

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Category:Coagulopathies

Category:Medical signs

Category:Hematopathology