Isolated mild/moderate thrombocytopenia may not require intervention
1. In a review of children who presented to a specialist hematology clinic with isolated mild or moderate low platelet counts, though causes were variable, most required no interventions.
2. Pediatric patients with isolated mild or moderate thrombocytopenia may not need specialist referral to hematology in most circumstances.
Evidence Rating Level: 2 (Good)
Study Rundown: In pediatric patients, low platelet counts are a frequent finding, with underlying causes ranging from completely benign to serious conditions, such as leukemia. Thus, low platelet count is a frequent cause for referral to a specialist pediatric hematologist. In this study, the authors reviewed a cohort of 113 patients referred to hematology for isolated mild or moderate low platelet counts; findings showed that 11% required intervention of any kind, and only 3% required hematology intervention. The causes of the low platelet counts in this cohort were varied, but most patients had low platelets due to either no known cause or to an immune thrombocytopenia. Most patients in the cohort later had normal platelet counts, suggesting that in many cases, the isolated mild or moderate low platelets self-resolve. Using these results, the authors suggested that general practitioners need not refer their patients to specialist hematologists for every case of isolated mild or moderate low platelets, and that reserving referrals would both improve efficiency of the health system and reduce unnecessary anxiety for patients and their families. This study was limited by its relatively small sample from a single institution, though these results provide a first set of data to assist providers in considering referrals, and repeat blood work.
Relevant Reading: Clinical practice: immune thrombocytopenia in pediatrics
In-Depth [retrospective cohort]: Participants were recruited at the University of Alabama at Birmingham (UAB) Pediatric Hematology-Oncology outpatient clinic from all patients with an ambulatory referral for isolated thrombocytopenia on complete blood count. Mild thrombocytopenia was defined as a platelet count between 101-140,000/ul, moderate between 51-100,000/ul, and severe as <50,000/ul. Of the 113 patients referred for evaluation of isolated thrombocytopenia, 48 presented with mild thrombocytopenia and 65 presented with moderate thrombocytopenia. 15 patients of the 113 required intervention, though most (12) from non-hematology specialties, particularly rheumatology or gastroenterology. Of the patients reviewed, none had severe thrombocytopenia after observation (87%) or intervention (13%) at the time the study concluded its analysis in January 2018, with periods of review ranging from 1 to 5 years for each child.
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