Gepost in: Hematologie
How do we approach thrombocytopenia in critically ill patients?
A low platelet count is a frequently encountered haematolog-ical abnormality in patients treated in intensive treatmentunits (ITUs). Although severe thrombocytopenia (plateletcount<209109/l) can be associated with bleeding, evenmoderate-degree thrombocytopenia is associated with organfailure and adverse prognosis. The aetiology for thrombocy-topenia in ITU is often multifactorial and correcting oneaetiology may not normalise the low platelet count. The clas-sical view for thrombocytopenia in this setting is consump-tion associated with thrombin-mediated platelet activation,but other concepts, including platelet adhesion to endothelialcells and leucocytes, platelet aggregation by increased vonWillebrand factor release, red cell damage and histonerelease, and platelet destruction by the complement system,have recently been described. The management of severethrombocytopenia is platelet transfusion in the presence ofactive bleeding or invasive procedure, but the risk-benefit ofprophylactic platelet transfusions in this setting is uncertain.In this review, the incidence and mechanisms of thrombocy-topenia in patients with ITU, its prognostic significance andthe impact on organ function is discussed. A practicalapproach based on the authors’ experience is described toguide management of a critically ill patient who developsthrombocytopenia.
Jecko Thachil and Theodore E. Warkentin
British Journal of Haematology, 2017,177,27–38 - First published online 16 December 2016doi: 10.1111/bjh.14482