Thrombocytopenia in patients in the medical intensive care unit: Bleeding prevalence, transfusion requirements, and outcome*

Abstract

Thrombocytopenia is common in medical intensive care unit patients. Thrombocytopenic patients have a higher prevalence of bleeding and greater transfusion requirements. A drop in platelet counts of > or = 30%, but not thrombocytopenia per se, is independently associated with intensive care unit death. Serial measurements of platelet counts are important and readily available markers for monitoring the patient's condition. Any drop in platelet count requires urgent clarification. Disseminated intravascular coagulation, signs of organ failure at admission, and cardiopulmonary resuscitation are predictors of intensive care unit-acquired thrombocytopenia.

Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and platelet autoantibodies

“…Very severe thrombocytopenia (platelets < 20 Â 10 9 /L [18]) often occurs with immune platelet destruction either in response to exogenous antigen (i.e., quinine, trimethoprim-sulfamethoxazole, post-transfusion purpura) or as an autoimmune phenomenon (ITP). In general, sepsis-associated thrombocytopenia tends to be less severe.…”

The management of abnormal haemostasis in the ICU

“…Platelet transfusions are broadly used in three clinical scenarios: firstly, when patients are bleeding as a direct result of trauma; secondly, for prophylaxis to prevent haemorrhage, particularly spontaneous intracranial haemorrhage when the count is low; and finally when patients have congenital or, more commonly, acquired platelet dysfunction. In practice, the platelet count is the trigger for most transfusions [28,29]. Despite this, the optimal platelet count is unknown.…”

Thrombocytopenia in the critically ill

“…L'étiologie de la thrombocytopénie dans le cadre de soins intensifs est, la plupart du temps, multifactorielle (c.-à-d. liée à un médicament, à un sepsis, à une coagulation intravasculaire disséminée, à une dilution), 8 et les scores de gravité de la maladie (ISS) sont en général plus élevés chez les patients atteints de thrombocytopénie. 9,10 La numération plaquettaire ayant été utilisée comme ISS, soit comme un prédicteur de dysfonctionnement des organes chez les patients septiques, 11 la thrombocytopénie pourrait également être un prédicteur d'ISS chez les patients en état critique présentant d'autres conditions médicales coexistantes. Peut-être que le temps est venu de modifier les approches cliniques à la thrombocytopénie : en d'autres termes, d'évaluer les implications au-delà des risques de saignement ainsi que les fonctions biologiques et la physiopathologie de la thrombocytopénie chez les patients atteints de maladies graves.…”

“…The etiology of thrombocytopenia in critical care settings is most often multifactorial (e.g., drug-related, sepsis-related, disseminated intravascular coagulation, dilutional), 8 and illness severity scores (ISS) are generally increased in thrombocytopenic patients. 9,10 As the platelet count has been used as an ISS, i.e., a predictor of organ dysfunction for patients with sepsis, 11 thrombocytopenia may also be a predictor of ISS in critically ill patients with other co-existing medical conditions. Perhaps now is the time for a change in clinical approaches to thrombocytopenia, namely, to evaluate the implications beyond the risks of bleeding as well as the biologic functions and related pathophysiology of thrombocytopenia in patients with critical illness.…”