Immune Thrombocytopenia (ITP) Differential Diagnoses

Updated: Jul 20, 2023
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MD, MS, FACP  more...
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Diagnostic Considerations

Common differential diagnoses of immune thrombocytopenia purpura (ITP) and possible alternative causes of thrombocytopenia identified by patient history include the following [46] :

  • Previously diagnosed or possible high risk for conditions that may be associated with ITP (eg, infections such as from HIV, hepatitis C virus, hepatitis B virus), autoimmune/immunodeficiency disorders (common variable immunodeficiency, systemic lupus erythematosus, or antiphospholipid syndrome), and malignancy (eg, lymphoproliferative disorders)
  • Liver disease (including cirrhosis or portal hypertension)
  • Splenomegaly
  • Drugs (prescription or nonprescription), including heparin, alemtuzumab, programmed death–1 inhibitors, abciximab, valproate, alcohol abuse, consumption of quinine (tonic water), exposure to environmental toxins, or chemotherapy
  • Bone marrow diseases, including myelodysplastic syndromes, leukemias, other malignancies, metastatic disease, myelofibrosis, aplastic anemia, megaloblastic anemia, myelophthisis, and Gaucher disease
  • Recent transfusions (rare possibility of posttransfusion purpura) and recent vaccinations
  • Inherited thrombocytopenia - Thrombocytopenia–absent radius syndrome, radioulnar synostosis, congenital amegakaryocytic thrombocytopenia, Wiskott-Aldrich syndrome, MYH9-related disease, Bernard-Soulier syndrome, type IIB von Willebrand disease (vWD), or platelet-type VWD
  • Other thrombocytopenic disorders (eg, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, Evans syndrome)

Differential Diagnoses