Abstract
New onset thrombocytopenia and multiple organ failure (TAMOF) presages poor outcome in critical illness. Patients who resolve thrombocytopenia by day 14 are more likely to survive than those who do not. Patients with TAMOF have a spectrum of microangiopathic disorders that includes thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC) and secondary thrombotic microanigiopathy (TMA). Activated protein C is effective in resolving fibrin-mediated thrombosis (DIC); however, daily plasma exchange is the therapy of choice for removing ADAMTS 13 inhibitors and replenishing ADAMTS 13 activity which in turn resolves platelet: von Willebrand Factor mediated thrombosis (TTP/secondary TMA).
Highlights
New onset thrombocytopenia in the critically ill patient has been established as an important independent risk factor for the development of multiple organ failure
Laboratory and clinical studies have confirmed that thrombocytopenia-associated multiple organ failure (TAMOF) is a thrombotic microangiopathic syndrome that can be defined by a spectrum of pathology that includes thrombotic thrombocytopenic purpura (TTP), secondary thrombotic microangiopathy (TMA), and disseminated intravascular coagulation (DIC)
A consensus is developing that reversal of microvascular thrombosis is a therapeutic target in patients with TAMOF defined by the clinical triad of new onset thrombocytopenia, multiple organ failure, and elevated lactate dehydrogenase (LDH) levels
Summary
New onset thrombocytopenia in the critically ill patient has been established as an important independent risk factor for the development of multiple organ failure. Laboratory and clinical studies have confirmed that thrombocytopenia-associated multiple organ failure (TAMOF) is a thrombotic microangiopathic syndrome that can be defined by a spectrum of pathology that includes thrombotic thrombocytopenic purpura (TTP), secondary thrombotic microangiopathy (TMA), and disseminated intravascular coagulation (DIC).
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