Background and Aims:In sickle cell disease (SCD) patients admitted for intensive care, evaluation of platelet counts in different types of sickle cell complications and its prognostic relevance are not well-studied. Illuminating these aspects were the objectives of this study.Materials and Methods:A chart review of 136 adult SCD patients consecutively admitted to our Intensive Care Unit (ICU) was done. The prognosis on day 1 was assessed by Acute Physiology and Chronic Health Evaluation (APACHE II) and multiple organ dysfunction scores (MODS). Receiver operating characteristic (ROC) curves evaluated the ability of platelet counts, MODS, and APACHE II scores to predict survival.Results:The most common types of crises were severe pain (n = 53), acute chest syndrome (n = 40), and infection (n = 18); 17 patients were nonsurvivors. Platelet counts varied widely (range, 19–838 × 109/L) with thrombocytopenia (n = 30) and thrombocytosis (n = 11). Counts correlated directly with leukocytes and reticulocytes; inversely with lactate dehydrogenase, APACHE, and MODS scores. Areas under ROC curve for platelets, MODS, and APACHE scores to predict survival were 0.73, 0.85, and 0.93, respectively.Conclusions:In severe sickle cell crisis thrombocytopenia is more common than thrombocytosis. In the ICU, day 1 platelet counts correlate inversely with prognostic scores and are significantly reduced in multi-organ failure and nonsurvivors. A platelet count above 175 × 109/L predicts patient survival with high specificity and positive predictive value but lacks sensitivity.

No abstract

Intensive care units (ICUs) are the focal points for emergence of multidrug resistant organisms [1]. Factors responsible for triggering the emergence of multidrug resistant organisms in critically ill patients include the following: aged > 65 years, prior antimicrobial therapy, or hospitalisation for ≥ 2 days in the last 3 months, in-home wound care, chronic dialysis within the last month and presence of a family member with a resistant microorganism or ongoing immunosuppressive treatment [2]. Several strategies have been shown to be beneficial in optimising antimicrobial therapy in critically ill patients, such as continuous infusion of beta-lactams and vancomycin and using procalcitonin for tapering and discontinuation of the antimicrobial drugs [3]. Novel strategies such as faecal microbiota transplantation and bacteriophage therapy have also been demon

No abstract