Thrombocytopenia in the Intensive Care Unit

Abstract

A 68-year-old male is admitted to the medical ICU with acute hypoxemic respiratory failure from community acquired pneumonia. He was recently hospitalized for acute cholecystitis during which he received prophylactic subcutaneous heparin. He is placed on invasive mechanical ventilation and given ceftriaxone and azithromycin. A lower extremity duplex ultrasound is performed for unilateral leg swelling which demonstrates an acute right femoral deep vein thrombosis. He is subsequently started on an infusion of unfractionated heparin. The following morning, his platelet count is noted to have dropped from 250 × 10 9 cells/L to 110 × 10 9 cells/L.

Research Advances in the Subtype of Sepsis-Associated Thrombocytopenia

“… 50 However, it is noteworthy that even after starting the antibiotic treatment, the microbial virulence factors may continue to exist in the microcirculation instead of instantly eradicating and damaging the platelet and vascular endothelial cells. 51 In addition, some antibiotics can cause thrombocytopenia per se, 52 such as linezolid 53 and vancomycin. 54 Therefore, other than the premise of adequate and appropriate anti-infection therapy, a pathophysiology-guided treatment is essential as well.…”