How do we approach thrombocytopenia in critically ill patients?

Abstract

A low platelet count is a frequently encountered haematological abnormality in patients treated in intensive treatment units (ITUs). Although severe thrombocytopenia (platelet count <20 × 10 /l) can be associated with bleeding, even moderate-degree thrombocytopenia is associated with organ failure and adverse prognosis. The aetiology for thrombocytopenia in ITU is often multifactorial and correcting one aetiology may not normalise the low platelet count. The classical view for thrombocytopenia in this setting is consumption associated with thrombin-mediated platelet activation, but other concepts, including platelet adhesion to endothelial cells and leucocytes, platelet aggregation by increased von Willebrand factor release, red cell damage and histone release, and platelet destruction by the complement system, have recently been described. The management of severe thrombocytopenia is platelet transfusion in the presence of active bleeding or invasive procedure, but the risk-benefit of prophylactic platelet transfusions in this setting is uncertain. In this review, the incidence and mechanisms of thrombocytopenia in patients with ITU, its prognostic significance and the impact on organ function is discussed. A practical approach based on the authors' experience is described to guide management of a critically ill patient who develops thrombocytopenia.

Risk factors for linezolid‐induced thrombocytopenia in patients without haemato‐oncologic diseases

“…These studies also applied the same definition of thrombocytopenia as that used in our study . Our study adopted the cut‐off value of <100 × 10 3 /mm 3 , which has been closely associated with an increased mortality rate and is a reference value for treatment decisions …”

A study to evaluate the prognostic significance of thrombocytopenia among critically ill children

“…these. [7][8][9][10] Prevalence of thrombocytopenia varies between 13% to 58% among different ICU settings. 11 Critically ill children admitted under intensive care, who have persisting thrombocytopenia are at higher risk for prolonged bleeding manifestation, prolonged duration of ICU or hospital stay, and even mortality.…”

Thrombocytopenia in critically ill patients due to vascular microthrombotic disease: pathogenesis based on “two activation theory of the endothelium”

“…This etiology-unidentified thrombocytopenia, encountered in critical illnesses (e.g., sepsis/septic shock, severe trauma, and complications of pregnancy, transplant and surgery), has been designated as "thrombocytopenia in critically ill patients" (TCIP) [1]. TCIP is now suspected to be an unfavorable indicator influencing the prognosis of the patient [2][3][4].…”