New-onset acute thrombocytopenia in hospitalized patients: pathophysiology and diagnostic approach

Ali, Naveed; Auerbach, Herbert E.

doi:10.1080/20009666.2017.1335156

Cited by 32 publications

(35 citation statements)

References 79 publications

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“…Out of 43 preterm neonates, 58.1% (n=25) had thrombocytopenia of which 52% (n=13), 28% (n=7) and 20% (n=5) had mild, moderate and severe thrombocytopenia respectively. Among term neonates (n=60), 36.7% (n=22) developed thrombocytopenia out of them 81.8% (n=18), 13.6% (n=3) and 4 preterm than term babies (58.1% vs 36.7%), which was statistically significant (p< 0.05) ( Table 1).…”

Section: Incidence Of Thrombocytopenia Based On Gestational Agementioning

confidence: 92%

“…Mild, moderate and severe thrombocytopenia were defined as platelet counts between 100,000-150,000/mm 3 ; 50,000-100,000/mm 3 and <50,000/mm 3 , respectively. 4 Neonates were then divided in two groups viz those with thrombocytopenia and those without thrombocytopenia. Variables like duration as well as the type of phototherapy and demographic factors such as sex, birth weight, gestational age, neonatal age and severity of thrombocytopenia were studied and compared in the two groups.…”

Section: Methodsmentioning

confidence: 99%

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Incidence of thrombocytopenia in neonates receiving phototherapy for indirect hyperbilirubinemia: a prospective cohort study

Shah¹,

Vedula²,

Roshan

2019

Int J Res Med Sci

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Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in the standard literature but was described briefly as isolated case reports after the phototherapy came in vogue in 1958. The purpose of this study was to find the incidence of thrombocytopenia in neonates with uncomplicated indirect hyperbilirubinemia receiving phototherapy in a referral hospital.Methods: This was a prospective cohort study conducted in a referral hospital over a period of 18 months from June 1, 2013 to November 1, 2014.Results: A total of 103 babies were enrolled. The overall incidence of post-phototherapy thrombocytopenia was 45.6% while mild, moderate and severe thrombocytopenia was present in 66%, 21.3% and 12.8% of babies respectively. The lowest platelet count observed was 31,000/mm3 but none of the neonates showed bleeding manifestations. The incidence of thrombocytopenia following phototherapy was significantly higher in preterm babies, infants who received double surface phototherapy, babies who received phototherapy for >72 hours and in babies who received phototherapy on day 2 or 3 of life.Conclusions: Neonates requiring phototherapy for hyperbilirubinemia are at risk of developing thrombocytopenia, hence the treatment should be initiated based on the standard guidelines. Unnecessary use and prolongation of phototherapy should be avoided considering the possible side effects. Platelet count should be monitored particularly in pre-term neonates receiving phototherapy. Neonates receiving double surface phototherapy and those requiring phototherapy for longer duration require more frequent platelet count monitoring.

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Section: Incidence Of Thrombocytopenia Based On Gestational Agementioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Incidence of thrombocytopenia in neonates receiving phototherapy for indirect hyperbilirubinemia: a prospective cohort study

Shah¹,

Vedula²,

Roshan

2019

Int J Res Med Sci

View full text Add to dashboard Cite

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“…e patient was diagnosed with acute ITP instead of drug-induced immune thrombocytopenia (DITP), although our assays were inconclusive. In general, DITP occurs 1 to 2 weeks after the initial administration of a particular drug with a sudden decrease in platelet counts to <100,000/μL [5,6]. is causes clinically significant hemorrhage in patients, and deaths have been reported [7].…”

Section: Discussionmentioning

confidence: 99%

A Sudden Onset of Severe Thrombocytopenia While Using Evolocumab

Inoue

Takenaka

Kin

et al. 2020

Case Reports in Hematology

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A 72-year-old man with a 10-year history of coronary heart disease started evolocumab treatment once a month after developing excess myalgia due to therapy with a 3-hydroxy-methylglutaryl CoA reductase inhibitor. No side effects such as myalgia symptoms had been reported during the first 14 months of evolocumab treatment; however, he suddenly presented with acute severe thrombocytopenia following the 14th treatment. His platelet count continued to decrease to a nadir of 1,000/μL. His platelet-associated immunoglobulin G level had elevated to 790 ng/107 cells. He started receiving a combination of steroid therapy, high-dose immunoglobulin therapy, and platelet transfusions, but the first-line therapy was ineffective. He was subsequently treated with a thrombopoietin receptor agonist, and his platelet count recovered to 250,000/μL.

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“…Thrombocytopenia, defined as a platelet count of <150 × 10 9 /L, is a common haematological abnormality in critically ill patients, affecting 25%‐55% of patients admitted to intensive care unit (ICU) patients . The development of thrombocytopenia in ICU patients can be attributed to a broad spectrum of aetiologies, which include hemodilution, infection, disseminated intravascular coagulation, consumption due to bleeding or trauma and exposure to certain drugs, such as heparin, cytotoxic anticancer agents and valproic acid (VPA) …”

Section: What Is Known and Objectivementioning

confidence: 99%

Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit

Kim

Lee

et al. 2020

J Clin Pharm Ther

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What is known and objective Thrombocytopenia is a common laboratory abnormality among critically ill patients under neurological intensive care unit (NCU) care. Valproic acid (VPA), a widely used antiepileptic drug, is one of the common causes of drug‐induced thrombocytopenia. The purpose of this study was to estimate the incidence and risk factors of thrombocytopenia after intravenous VPA therapy among the patients admitted to NCU. Methods We retrospectively reviewed the medical records of patients who were treated with intravenous VPA during their NCU stay between January 2014 and December 2018. We studied the frequency of thrombocytopenia and further evaluated the risk of thrombocytopenia in these patients. Results Among the 283 patients (181 male [64.0%], mean age: [61.0 ± 14.9] years) who were treated with intravenous VPA, thrombocytopenia was observed in 104 patients (36.7%). Thrombocytopenia was associated with several risk factors, including lower baseline platelet counts (<200 × 109/L); aetiologies other than intracranial or subarachnoid haemorrhage; longer use of VPA (more than 3 days); higher daily dose of VPA (more than 1000 mg/d); concurrent use of VPA with other antiepileptic drugs; infection; and the use of mechanical ventilation. Multivariate analysis found several independent risk factors of thrombocytopenia with intravenous VPA therapy, including lower baseline platelet counts, aetiologies other than intracranial or subarachnoid haemorrhage, use of VPA for more than 3 days and infection. What is new and conclusion Thrombocytopenia is common in NCU patients. Because several clinical and laboratory factors are associated with thrombocytopenia, careful use of VPA should be considered in patients with these risk factors.

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New-onset acute thrombocytopenia in hospitalized patients: pathophysiology and diagnostic approach

Cited by 32 publications

References 79 publications

Incidence of thrombocytopenia in neonates receiving phototherapy for indirect hyperbilirubinemia: a prospective cohort study

Incidence of thrombocytopenia in neonates receiving phototherapy for indirect hyperbilirubinemia: a prospective cohort study

A Sudden Onset of Severe Thrombocytopenia While Using Evolocumab

Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit

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