Abstract
BackgroundThrombocytopenia is common in the intensive care unit. Potential mechanisms and etiologies behind this phenomenon are multiple and often entangled. We assessed the effect of a systematic approach, using routinely available tests, on the proportion of patients in whom the mechanism (primary objective) and etiology (secondary objective) of thrombocytopenia in a mixed intensive care unit (ICU) could be identified.MethodsBefore-and-after study of all patients with thrombocytopenia was used. ‘Before’ group had no intervention. New standard operating procedures for thrombocytopenia management were introduced. In the ‘After’ group, bone marrow aspiration; determination of fibrinogen dosage, prothrombin time, factor V, D-dimers; assay of fibrin monomers, ferritin, triglycerides, lactic acid dehydrogenase, aspartate transaminase, alanine aminotransferase, vitamin B12, folates, reticulocytes, haptoglobin, and bilirubin were performed.ResultsIn the Before group (n = 20), the mechanism (central, peripheral, or mixed) was identified in 10 % versus 83% in After group (n = 23) (p < 0.001) (48% peripheral, 35% mixed). Before intervention, ≥1 etiology was identified in 15% versus 95.7% in the After group (p < 0.001).ConclusionsSystematic and extensive investigation using routine tests highlights the mechanisms and etiology of thrombocytopenia in most cases.
Highlights
Thrombocytopenia is common in the intensive care unit
Thrombocytopenia is defined as a platelet count of
International Society for Thrombosis and Hemostasis (ISTH) criteria in search of arguments in favor of disseminated intravascular coagulation (DIC) were performed for 14 patients; detection of heparininduced anti-platelet antibodies was performed for two patients; and one bone marrow aspiration (BMA) was performed
Summary
Thrombocytopenia is common in the intensive care unit. We assessed the effect of a systematic approach, using routinely available tests, on the proportion of patients in whom the mechanism (primary objective) and etiology (secondary objective) of thrombocytopenia in a mixed intensive care unit (ICU) could be identified. Thrombocytopenia is the most common hemostatic disorder in the intensive care unit (ICU) with a prevalence of around 50% [1,2]. Current guidelines [10] recommend that bone marrow aspiration (BMA) should not be systematic, but rather should only be considered in the absence of any obvious etiology of thrombocytopenia or if other cell lines are affected. Thrombocytopenia in the ICU setting is often multifactorial [9], frequently involving both central and peripheral mechanisms. In theory, BMA should be discussed for all thrombocytopenic patients
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