Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
As mentioned earlier, thrombocytopenia is usually
detected incidentally from routine blood work done for other reasons. Platelets
are a component of the complete blood count (CBC) which also contains information on red blood
cells and
white blood cells.
If thrombocytopenia is seen for the first time, it is
prudent to repeat the complete blood count in order to rule out
pseudothrombocytopenia (see above). If
the repeat CBC confirms low platelet counts, then further evaluation can begin.
Once detected, the cause of thrombocytopenia may be investigated by the
doctor. The most essential part of this evaluation includes a thorough physical
examination and medical history
of the patient. In the medical history, the complete
list of all medications is routinely reviewed. Some of the other important
components of the history include reviewing previous known history of low
platelet count, family history of thrombocytopenia, recent infections, any
previous cancers, other autoimmune disorders, or liver disease.
A review of the symptoms related to excessive bleeding or bruising can also
provide additional information. As a part of a thorough physical examination,
special attention may be given to the skin and mucus membrane in the oral cavity
for petechiae or purpura or other signs of bleeding. On the abdominal
examination, an enlarged spleen
(splenomegaly) can provide important diagnostic
clues.
The urgency to perform additional testing and evaluation
is largely dependent on how low the platelet count is on the blood count, and
what the clinical situation may be. For instance, in a person who needs a
surgery and has a
platelet count of less than 50 the investigation will take precedence over one
whose thrombocytopenia was detected on a yearly blood work with a platelet of
100.
A comprehensive review of the other components of the CBC is one of the most
important steps in the evaluation of low platelet count. The CBC can tell us
whether other blood disorders may be present, such as, anemia (low red cell
count or hemoglobin), erythrocytosis (high red blood cell count or hemoglobin),
leukopenia (low white cells count), or leukocytosis (elevated white blood cell
count). These abnormalities may suggest bone marrow problems as the potential
cause of thrombocytopenia. Abnormally shaped or ruptured red cells
(schistocytes) seen on the blood smear may suggest evidence of HELLP, TTP, or
HUS (see above).
Another clue in the CBC is the mean platelet volume or
MPV, which is an estimate of the average size of platelets in the blood. A low
MPV number may suggest platelet production problem, whereas, a high number may
indicate
increased destruction.
It is important to also review other blood work
including the complete metabolic panel, coagulation panel, and urinalysis.
Certain abnormalities in these tests can suggest advanced liver disease
(cirrhosis), kidney problems (renal failure), or other pertinent underlying medical conditions.
In some causes of thrombocytopenia, such as HIT or ITP,
additional testing with antibodies or assays may be done. Bone marrow biopsy can sometimes be
performed if a bone marrow problem is suspected.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Non-Hodgkin's lymphoma is cancer of the lymphatic system, a vital part of the body's immune system. Symptoms include swollen lymph nodes, fever, night sweats, coughing, weakness, chest pain, unexplained weight loss, and abdominal pain. Treatment depends on which type of non-Hodgkin's lymphoma you have, the stage of the cancer, your age, how fast the cancer is growing, and whether you have other health problems.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
A hematoma is a collection of blood that is outside a blood vessel. There are different areas where hematomas occur including the inside the skull, scalp, ear, septum, bones, finger and toenails, and intra-abdominal. Treatment for hematomas depend on the type and location of the hematoma.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Pernicious anemia is a blood disorder in which the body does not make enough red blood cells due to a lack of vitamin B12 in the blood. Pernicious anemia can develop from a lack of a protein that helps the body absorb vitamin B12, not getting enough B12 in the diet, and certain intestinal conditions that interfere with the absorption of vitamin B12 such as Crohn's disease, celiac sprue, or ulcerative colitis. There is no cure for pernicious anemia, thus treatment is life-long.
Vasculitis is a general term for a group of uncommon diseases which feature inflammation of the blood vessels. Each form of vasculitis has its own characteristic pattern of symptoms. The diagnosis of vasculitis is definitively established after a biopsy of involved tissue demonstrates the pattern of blood vessel inflammation. Treatment is directed toward decreasing the inflammation of the arteries and improving the function of affected organs.
Fifth disease (Erythema infectiosum) is caused by a virus known as parvovirus B 19. Symptoms include low-grade fever, fatigue, a "rash," and a rash over the whole body. The name fifth disease reflects the historical belief that it was one of the five diseases that produced a rash in children.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Mumps is an acute viral illness caused by the mumps virus. Symptoms of mumps include fever, headache, muscle aches, tiredness, and loss of appetite; followed by swelling of the salivary glands.
Idiopathic means that the cause of the condition isn't known. Thrombocytopenic means there's a lower than normal number of platelets in the blood. Purpura refers to purple bruises caused by bleeding under the skin. Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets.
German measles is a disease that's caused by a virus. Symptoms include rash and fever for two to three days. The MMR (measles, mumps, and rubella) vaccine prevents this disease.
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