HNY Policy and Pathway Repository - North Yorkshire

Platelets < 150 ×10⁹/L

Platelets < 20

• Active bleeding
• Blasts in film
• Fragments in film
• Altered conscious level or confusion

If platelet clumps on blood film:

• Likely pseudothrombocytopenia (in vitro phenomenon)
• Consider Citrate platelet count and if normal no action required

Causes

• Spurious result from clumping – please look at blood film report and repeat using citrated sample
• Immune thrombocytopenic purpura (ITP)
• Alcohol
• Liver dysfunction
• B12/folate deficiency
• HIV/hepatitis B/C
• Bone marrow failure/infiltration

Investigations:

• Blood film if not already done
• B12, folate, ferritin
• U+E, LFT
• Review medications
• OH history
• TFT
• HIV/Hep B/C screen
• US abdomen if RF for liver disease or abnormal LFTs

D/W on call Haematology to arrange urgent direct assessment if:

• Platelets < 20
  • Active bleeding
  • Blasts in film
  • Fragments in film
  • Altered conscious level or confusion

Refer urgently to Haematology if:

• Platelets < 50 ×10⁹/L OR
  • Associated with cytopenias
  • Splenomegaly
  • Lymphadenopathy
  • Pregnancy
  • Upcoming surgery
• Repeat FBC in 1 week - if persistent then urgent referral

Consider routine referral to haematology:

• Platelets > 50 ×10⁹/L
• Repeat FBC in 6 weeks and look for causes
  • If PLT 50–80 then consider routine referral

  • If 80–150 → Repeat FBC in 4–6 months, and if stable no further action. If below 80, consider referral as above.

• Harrogate and District