Lyme Disease & Thrombocytopenia: Mechanism, Diagnosis & Management
Lyme disease (Borrelia burgdorferi) can cause thrombocytopenia (platelets <150k/µL) via:
- Immune-mediated platelet destruction (molecular mimicry)
- Bone marrow suppression
- Splenic sequestration (splenomegaly)
- DIC in severe disseminated disease
Clinical Clues
- Easy bruising, petechiae, epistaxis, gingival bleeding
- May accompany erythema migrans, arthritis, neuroborreliosis
Workup
- CBC with peripheral smear
- Lyme serology (two-tier: ELISA → Western blot)
- Exclude other causes: medications, autoimmune, liver/spleen disease, B12/folate deficiency
Treatment
- Treat Lyme: doxycycline/amoxicillin/ceftriaxone per stage
- Platelets usually recover with antimicrobial therapy
- Severe thrombocytopenia (<20k or bleeding): IVIG, steroids, platelet transfusion
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