Thrombocytopenia in the Intensive Care Unit Patient

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 135-143 ◽  
Author(s):  
Andreas Greinacher ◽  
Kathleen Selleng
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Bone Marrow Failure ◽  
Major Surgery ◽  
Initial Increase ◽  
Severe Thrombocytopenia ◽  
Abrupt Decrease ◽  
Heparin Induced Thrombocytopenia ◽  
Platelet Counts

Abstract The many comorbidities in the severely ill patient also make thrombocytopenia very common (∼ 40%) in intensive care unit patients. The risk of bleeding is high with severe thrombocytopenia and is enhanced in intensive care patients with mild or moderately low platelet counts when additional factors are present that interfere with normal hemostatic mechanisms (eg, platelet function defects, hyperfibrinolysis, invasive procedures, or catheters). Even if not associated with bleeding, low platelet counts often influence patient management and may prompt physicians to withhold or delay necessary invasive interventions, reduce the intensity of anticoagulation, order prophylactic platelet transfusion, or change anticoagulants due to fear of heparin-induced thrombocytopenia. One approach to identify potential causes of thrombocytopenia that require specific interventions is to consider the dynamics of platelet count changes. The relative decrease in platelet counts within the first 3 to 4 days after major surgery is informative about the magnitude of the trauma or blood loss, whereas the dynamic of the platelet count course thereafter shows whether or not the physiologic compensatory mechanisms are working. A slow and gradual fall in platelet counts developing over 5 to 7 days is more likely to be caused by consumptive coagulopathy or bone marrow failure, whereas any abrupt decrease (within 1–2 days) in platelet counts manifesting after an initial increase in platelet counts approximately 1 to 2 weeks after surgery strongly suggests immunologic causes, including heparin-induced thrombocytopenia, other drug-induced immune thrombocytopenia, and posttransfusion purpura.

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

2019 ◽  
Vol 6 (2) ◽  
pp. 540
Author(s):  
Suneel C. Mundkur ◽  
Ranjani Upadhyay ◽  
Shrikiran A. Hebbar ◽  
Pushpa Kini ◽  
Nalini Bhaskarananda ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Platelet Count ◽  
Prognostic Significance ◽  
Critically Ill Children ◽  
Study Group ◽  
Severe Thrombocytopenia ◽  
Common Cause ◽  
Platelet Counts

Background: Pediatric critical care differs from Adult critical care not only in age but also in the outcomes. There are no studies regarding thrombocytopenia in the pediatric population. Therefore, in the current study, our objective was to study the prevalence and, the severity of thrombocytopenia, clinical features, and prognostic significance of low platelet count as an independent predictor of mortality and prolonged hospital and ICU stay.Methods: This was a prospective observational study conducted at tertiary care paediatric intensive care unit in India. Children between 1 month to 18 years admitted to the Pediatrics intensive care unit with thrombocytopenia due to any cause at admission were involved in the study. Detailed history was documented. Haemoglobin levels, total leucocyte counts, platelet counts, and platelet indices were recorded on the first and fourth day of admission. Outcomes were analysed in term of survivors and non-survivors and duration of ICU and hospital stay.Results: The study group consisted of 150 children with mean age of 8.458(± 5.604) years. Majority of children in the study group had severe thrombocytopenia 77 (51.3%). Moderate and mild thrombocytopenia was seen in 35(23.3%) and 38(25.4%) children respectively. Infection (50.66%) was the most common cause of thrombocytopenia, followed by sepsis (10.66%). Sepsis (27.5%) was observed to be the most common cause of mortality. Rise in platelet count on the fourth day among survivors, and no survivors were observed in 79.1% and 15.9% respectively.  Failure of the rise in platelet count on the fourth day of admission was significantly associated with mortality (p value=0.001). The severity of thrombocytopenia does not correlate with duration of hospital and ICU stay.Conclusions: Platelet counts and indices at the time of admission to a critical care unit have limited use as a prognostic marker for predicting mortality in children.

scholarly journals Mild thrombocytopenia indicating maternal organ damage in pre‐eclampsia: a cross‐sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michinori Mayama ◽  
Mamoru Morikawa ◽  
Takashi Yamada ◽  
Takeshi Umazume ◽  
Kiwamu Noshiro ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Organ Damage ◽  
Severe Thrombocytopenia ◽  
Relative Risks

Abstract Background Currently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of < 100 × 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of < 150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count < 150 × 109/L and ≥ 100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. Methods A total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥ 150 × 109/L; mild thrombocytopenia, < 150 × 109/L and ≥ 100 × 109/L; and severe thrombocytopenia, < 100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Estimated relative risk was calculated with a Poisson regression analysis with a robust error. Results Platelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The estimated relative risks of severe thrombocytopenia were 4.46 [95 % confidence interval, 2.59–7.68] for maternal organ damage except for thrombocytopenia, 1.61 [1.06–2.45] for preterm delivery < 34 gestational weeks, and 1.35 [1.06–1.73] for neonatal intensive care unit admission. On the other hand, the estimated relative risks of mild thrombocytopenia were 0.97 [0.41–2.26] for maternal organ damage except for thrombocytopenia, 0.91 [0.62–1.35] for preterm delivery < 34 gestational weeks, and 0.97 [0.76–1.24] for neonatal intensive care unit admission. Conclusions Mild thrombocytopenia was not associated with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

scholarly journals Risk Factors of Hospital-acquired Thrombocytopenia in Toxicological Intensive Care Unit

2020 ◽  
Vol 10 (3) ◽  
pp. 32256-32256
Author(s):  
Haleh Talaie ◽  
◽  
Sayed Masoud Hosseini ◽  
Maryam Nazari ◽  
Mehdi Salavati Esfahani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Platelet Count ◽  
Antihypertensive Drugs ◽  
International Normalized Ratio ◽  
Severe Thrombocytopenia ◽  
Old Patients ◽  
Platelet Counts ◽  
Hospital Acquired ◽  
The Impact

Background: Platelet count is a readily available biomarker predicting disease severity and risk of mortality in the intensive care units (ICU). This study aims to describe the frequency, to assess the risk factors, and to evaluate the impact of thrombocytopenia on patient outcomes in a Toxicological ICU (TICU).Methods: In this prospective observational Cohort study, we enrolled 184 patients admitted to our TICU from October 1st, 2019, to August 23rd, 2020. Mild/moderate and severe thrombocytopenia were defined as at least one platelet counts less than 150×103/μL and 50×103/μL during the ICU stay, respectively.Results: Of 184 enrolled patients, 45.7% had mild to moderate thrombocytopenia and 5.4% had severe thrombocytopenia. Old age (OR: 1.042, 95%CI: 1.01-1.075, P=0.01), male gender (OR: 4.348, 95%CI: 1.33-14.22, P=0.015), increased international normalized ratio (INR) levels (OR: 3.72, 95%CI: 1.15-112, P=0.028), and administration of some medications including heparin (OR: 3.553, 95%CI: 1.11-11.36, P=0.033), antihypertensive drugs (OR: 2.841, 95%CI: 1.081-7.471, P=0.034), linezolid (OR: 13.46, 95%CI: 4.75-38.13, P<0.001), erythromycin (OR: 19.58, 95%CI: 3.23-118.86, P=0.001), and colistin (OR: 10.29, 95% CI 1.44-73.69, P=0.02) were the risk factors of hospital-acquired thrombocytopenia. The outcomes of patients with normal platelet count were significantly better than those who developed thrombocytopenia (P<0.001).Conclusion: We found that thrombocytopenia could develop in almost 50% of patients admitted to TICU, which is associated with poor prognosis. Additionally, the platelet counts should be closely monitored to administer some medications (heparin, antihypertensive drug, and linezolid), especially in old patients.

scholarly journals Heparin-induced thrombocytopenia and COVID-19

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Michelangelo Sartori ◽  
Benilde Cosmi
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Platelet Count ◽  
Respiratory Failure ◽  
Heparin Dose ◽  
Heparin Induced Thrombocytopenia ◽  
Calcium Heparin ◽  
Possible Cause

Heparin-induced thrombocytopenia (HIT) has not been included as a possible cause of thrombocytopenia in Coronavirus Disease 2019 (COVID-19) patients. We report a case of HIT in a patient with COVID-19 treated with heparin. A 78-yearold man was admitted to our hospital for acute respiratory failure and acute renal failure due to SARS-CoV-2 infection; in intensive care unit, one 5000IU heparin dose (day 0, platelet count 305000/μL). On day 2, haemoglobin started to decrease and heparin was stopped. On day 10, platelet count was 153000/μL and 5000IU calcium heparin subcutaneously twice daily was started. The platelet further decreased, reaching 49000/μL on day 17, and the patient was investigated for suspected HIT: an IgG specific chemiluminescence test for heparin- PF4 antibodies was positive and a femoral DVT was found at ultrasound. Argatroban was started, platelet count increased without any bleeding and thrombosis complication. Our experience shows that HIT may develop in heparin treated COVID-19 patients and should be included among the possible cause of thrombocytopenia in such patients.

scholarly journals Thrombocytopenia in 737 adult intensive care unit patients: A real-world study of associated factors, drugs, platelet transfusion, and clinical outcome

2020 ◽  
Vol 8 ◽  
pp. 205031212095890
Author(s):  
Man-ka Zhang ◽  
Tian-qi Xu ◽  
Xiao-jing Zhang ◽  
Zhi-guo Rao ◽  
Xiao-xu He ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bacterial Infection ◽  
Platelet Transfusion ◽  
Severe Thrombocytopenia ◽  
Chi Square ◽  
Adult Intensive Care Unit ◽  
Factors Associated ◽  
Platelet Counts ◽  
Chi Square Test

Objective: We aimed to identify and represent factors associated with thrombocytopenia in intensive care unit, especially the pathogens and drugs related to severe and extremely thrombocytopenia. Then, we aim to compare the mortality of platelet transfusion and non-transfusion in patients with different degrees of thrombocytopenia. Methods: We identified all thrombocytopenic patients in intensive care unit by using platelet-specific values and then extracted electronic health records from our Hospital Information System. Data were statistically analyzed with t test, chi-square test, and logistic regression. Results: We found that infections (32.7%) were the most frequent cause associated with thrombocytopenia, followed by sepsis shock (3.93%) and blood loss (2.99%). Meanwhile, antifungals ( p = 0.002) and bacterial infection ( p = 0.037) were associated with severe and extremely severe thrombocytopenia. Finally, we found that the mortality of platelet transfusion and non-transfusion in patients was statistically significant for patients with platelet counts between 30 and 49/nL (χ2 = 9.719, p = 0.002). Conclusion: Infection and sepsis emerged as two primary factors associated with thrombocytopenia in intensive care unit. Meanwhile, antifungals and bacterial infection were associated with platelet counts less than 49/nL. Finally, platelet transfusion may be associated with reduced mortality in patients with platelet counts between 30 and 49/nL.

Effect of presence of severe thrombocytopenia on prognosis of hepatic patients in intensive care unit

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Ali Fawaz Ahmed ◽  
Ahmed Mohammed Elsayed Elhenawy ◽  
Wael Abd-Almonem M Abd-Alwahab ◽  
Mahmoud Salem Elsayed Salem
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Apache Ii Score ◽  
Severe Thrombocytopenia ◽  
Normal Platelet Count ◽  
Normal Platelet

Abstract Background Thrombocytopenia is defined as a platelet count below 150,000/μL.It is the most common hematological complication in patients with chronic liver disease (CLD).The prevalence of thrombocytopenia in chronic liver diseases ranges from 6 % among non-cirrhotic patients with chronic liver disease to 70 % among patients with liver cirrhosis. Objective To investigate the association between thrombocytopenia and the risk of higher mortality incidence in hepatic patients in intensive care unit. Patients and Methods The present prospective cohort study was conducted at Ain Shams University hospitals Intensive care units, from October 2019 to August 2020. After obtaining approval of the study protocol from the local ethical committee, as well as fully informed consents signed by the patient closet relative, 130 hepatic patients admitted at ICU with hepatic coma and patients classified according to platelet count on admission into two equal groups. Group A: included 65 Patients with thrombocytopenia on admission (&lt;100,000/μL). Group B: included 65 Patients with normal platelet count on admission with persistently normal platelet count (≥100,000/μL). Results Our study revealed that patients with lower platelet counts had significantly higher risk of death and ICU stay. In our study we showed that there are two independent risk factors affecting the outcome of hepatic patients in the ICU they were thrombocytopenia and high APACHE score. These observations highlight the potential importance of low platelets count in identifying a group of hepatic patients who are at risk for poorer prognosis. Conclusion Thrombocytopenia is a frequent laboratory finding among hepatic patients, which is generally correlated to the severity of illness. Thrombocytopenia is generally associated with higher APACHE II score when compared to normal platelet count indicating that it is associated with higher degree of morbidity and expected higher mortality rate.

scholarly journals Mild thrombocytopenia indicating maternal organ damage in pre-eclampsia: a cross-sectional study

2020 ◽  
Author(s):  
Michinori Mayama ◽  
Mamoru Morikawa ◽  
Takashi Yamada ◽  
Takeshi Umazume ◽  
Kiwamu Noshiro ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Organ Damage ◽  
Severe Thrombocytopenia ◽  
Adjusted Risk

Abstract BackgroundCurrently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of <100× 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of <150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count <150 × 109/L and ≥100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. MethodsA total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥150 × 109/L; mild thrombocytopenia, <150 × 109/L and ≥100 × 109/L; and severe thrombocytopenia, <100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Adjusted relative risk were calculated with a Poisson regression analysis with a robust error. ResultsPlatelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The adjusted risk ratios of severe thrombocytopenia were 2.11 [95% confidence interval, 1.61–2.77] for maternal organ damage except thrombocytopenia, 1.24 [1.01–1.53] for preterm delivery <34 gestational weeks, and 1.16 [1.02–1.32] for neonatal intensive care unit admission. On the other hand, the adjusted risk ratios of mild thrombocytopenia were 1.06 [0.86–1.30] for severe hypertension, 1.17 [0.74–1.83] for utero-placental dysfunction, 0.96 [0.41–2.24] for maternal organ damage except thrombocytopenia, 0.89 [0.60–1.31] for preterm delivery <34 gestational weeks, and 0.96 [0.75–1.23] for neonatal intensive care unit admission. ConclusionsMild thrombocytopenia was not related with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

scholarly journals Thrombocytopenia in the intensive care unit

2018 ◽  
Vol 35 (1) ◽  
Author(s):  
Zohreh Ostadi ◽  
Kamran Shadvar ◽  
Sarvin Sanaie ◽  
Ata Mahmoodpoor ◽  
Seied Hadi Saghaleini
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Time Course ◽  
The Body ◽  
Major Surgery ◽  
Icu Patients ◽  
Creative Commons ◽  
Minor Surgery ◽  
Open Access Article

Thrombocytopenia is a frequent finding in intensive care unit especially among adults and medical ICU patients.Thrombocytopenia is defined as a platelet count less than 100×109/l in ICU setting. Platelets are made in the bone marrow from megakaryocytes. Although not fully understood, proplatelets transform into platelets in the lung. The body tries to maintain platelet count relatively constant throughout life. Pathophysiology of thrombocytopenia can be defined by hemodilution, elevated levels of platelet consumption, compromise of platelet production, increased platelet sequestration and increased platelet destruction. Unlike in other situations, absolute platelet count alone does not provide sufficient data in characterizing thrombocytopenia in ICU patients. In such cases, the time course of changes in platelet count is also pivotal. The dynamics of platelet count decrease vary considerably between different ICU patient populations including trauma, major surgery and minor surgery/medical conditions.There are strong evidences available that delay in platelet count restoration in ICU patients is an indicator of a bad outcome. How to cite this:Ostadi Z, Shadvar K, Sanaie S, Mahmoodpoor A, Saghaleini SH. Thrombocytopenia in the intensive care unit. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.19 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Immature platelet values indicate impaired megakaryopoietic activity in neonatal early-onset thrombocytopenia

2010 ◽  
Vol 103 (05) ◽  
pp. 1016-1021 ◽  
Author(s):  
Hannes Hammer ◽  
Christoph Bührer ◽  
Christof Dame ◽  
Malte Cremer ◽  
Andreas Weimann
Keyword(s):  
Bone Marrow ◽  
Flow Cytometry ◽  
Intensive Care ◽  
Early Onset ◽  
Absolute Number ◽  
Severe Thrombocytopenia ◽  
Platelet Counts ◽  
Immature Platelet Fraction ◽  
Neonatal Thrombocytopenia ◽  
Immature Platelets

SummaryNewly released platelets, referred to as immature platelets, can be reliably quantified based on their RNA content by flow cytometry in an automated blood analyser. The absolute number of immature platelets (IPF#) and the immature platelet fraction (IPF%) reflect megakaryopoietic activity. We aimed to analyse the implication of these parameters in analysing the pathomechanism of early-onset neonatal thrombocytopenia. Platelet counts and IPF were determined at day 1 to 3 (d1 to d3) in 857 neonates admitted to intensive care. In thrombocytopenic patients (platelet counts<150 x 109/l, n=129), IPF# was significantly lower (8.5 ± 2.7 x 109/l), than in non-thrombocytopenic neonates (9.5 ± 3.6 x 109/l, n=682, p<0.05). IPF% was significantly higher in thrombocytopenic (9.3 ± 7.9%) vs. non-thrombocytopenic neonates (4.1 ± 1.8%, p<0.001). While neonates with early-onset infection (n=134) had lower platelet counts (199 ± 75 x 109/l) compared to controls (230 ± 68 x 109/l, n=574, p<0.01), there were no differences in IPF# or IPF%. Likewise, “small for gestational age” infants (SGA, n=149) had lower platelet counts at d1 (199 ± 75 x 109/l, p<0.001) than controls, but no differences in IPF. A trend towards lower IPF# was detected if SGA infants with platelet counts <100 x 109/l (5.4 ± 3.9 x 109/l, n=11) and thrombocytopenic neonates with infection (9.9 ± 7.3 x 109/l, n=10, p=0.11) were compared. The evaluation of IPF# indicates that thrombocytopenia in neonates is likely due to a combination of increased platelet consumption and inadequate megakaryopoietic response by the neonatal bone marrow. Furthermore, SGA neonates with moderate and severe thrombocytopenia might have a pronounced suppression of megakaryopoiesis compared to neonates with infection.

Surgical intensive care unit (ICU) delirium: A “psychosomatic” problem?

2010 ◽  
Vol 8 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Michel Reich ◽  
Regis Rohn ◽  
Daniele Lefevre
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Psychological Factors ◽  
Death Anxiety ◽  
Defense Mechanism ◽  
Cognitive Disorders ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Delirium

AbstractObjective:Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field.Method:To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety.Results:With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit.Significance of results:ICU delirium can sometimes be considered as a “psychosomatic” problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this “psychosomatic” problem.

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