The Fellow on Call: The Heme/Onc Podcast
Jun 17, 2026 · 27 min · 8 segments
This week, we go back to Classical Hematology! We previously discussed the initial workup and management of ITP in Episode 009, but now it’s time to dig deeper. What do we do once we make the…
Yeah.
So we have a twenty-three-year-old female with no past medical history who comes to the emergency department with several days of spontaneous bruising on her arms and legs, as well as a new rash on her lower extremities.
On a review of systems, she also endorses an episode of epistaxis and some increased gum bleeding while brushing during this time.
She denies any recent infections or new medications.
She has no family history of bleeding disorders.
Vital signs are normal.
Her exam is notable for multiple ecchymosis on her arms and legs, as well as petechiae on her shins.
Her workup was notable for an isolated thrombocytopenia with a platelet count of twelve.
Notably, her prior baseline was one hundred and eighty-nine on an outpatient CBC done two years prior to that.
Coag studies were normal.
A stat hematology consult was placed, so this happens to us all the time.
Where do we go from here? What's the initial workup for a patient with newly diagnosed thrombocytopenia?
So definitely check out our thorough overview thrombocytopenia workup in episode nine, so way back in the day.
And, uh, just remember that it's very important to give a broad workup whenever you're faced with thrombocytopenia.
There are a lot of urgent, immediately dangerous causes for this.
But we like to analogize our approach to this like you would with working up an AKI, a kidney injury, looking at sort of pre-platelet, intraplatelet, and post-platelet, or pre-marrow, intra-marrow, and post-marrow.
So for pre-marrow, so like good marrow, bad world, we're thinking about infections, medications, toxins, that sort of thing.
Things like HIV, hepatitis C, these are common viral precipitants of ITP.
And then things that might-- and then infections that might more affect the bone marrow, things like your Epstein-Barr virus, cytomegalovirus, histoplasmosis, some of these endemic fungi that can get in the marrow and cause trouble.
As far as intra-marrow processes, this is things like primary bone marrow failure, aplastic anemia.
Again, more likely to be pancytopenia in that case, and so a little bit less common for that to just be thrombocytopenia.
Then our post-marrow, so things that are destroying the platelets or excessively consuming them.
Also, of course, we'll include platelet clumping here, so always look at the smear.
Yeah.
So we have a twenty-three-year-old female with no past medical history who comes to the emergency department with several days of spontaneous bruising on her arms and legs, as well as a new rash on her lower extremities.
On a review of systems, she also endorses an episode of epistaxis and some increased gum bleeding while brushing during this time.
She denies any recent infections or new medications.
She has no family history of bleeding disorders.
Vital signs are normal.
Her exam is notable for multiple ecchymosis on her arms and legs, as well as petechiae on her shins.
Her workup was notable for an isolated thrombocytopenia with a platelet count of twelve.
Notably, her prior baseline was one hundred and eighty-nine on an outpatient CBC done two years prior to that.
Coag studies were normal.
A stat hematology consult was placed, so this happens to us all the time.
Where do we go from here? What's the initial workup for a patient with newly diagnosed thrombocytopenia?
So definitely check out our thorough overview thrombocytopenia workup in episode nine, so way back in the day.
And, uh, just remember that it's very important to give a broad workup whenever you're faced with thrombocytopenia.
There are a lot of urgent, immediately dangerous causes for this.
But we like to analogize our approach to this like you would with working up an AKI, a kidney injury, looking at sort of pre-platelet, intraplatelet, and post-platelet, or pre-marrow, intra-marrow, and post-marrow.
So for pre-marrow, so like good marrow, bad world, we're thinking about infections, medications, toxins, that sort of thing.
Things like HIV, hepatitis C, these are common viral precipitants of ITP.
And then things that might-- and then infections that might more affect the bone marrow, things like your Epstein-Barr virus, cytomegalovirus, histoplasmosis, some of these endemic fungi that can get in the marrow and cause trouble.
As far as intra-marrow processes, this is things like primary bone marrow failure, aplastic anemia.
Again, more likely to be pancytopenia in that case, and so a little bit less common for that to just be thrombocytopenia.
Then our post-marrow, so things that are destroying the platelets or excessively consuming them.
Also, of course, we'll include platelet clumping here, so always look at the smear.
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