Thrombocytopenia in Critical Care Unit: Risk Factors, Etiologies, and Management
Main Article Content
Abstract
Introduction: Thrombocytopenia is a platelet count below 150,000/mm3. It is a frequent abnormality in critically ill patients.
Methods: We conducted a retrospective study which included 603 patients admitted to the medical intensive care unit in the Ibn Rochd university hospital of Casablanca over a two years period, from January 1, 2018 to December 31, 2019. The aim of the study is to point out the incidence, risk factors, etiologies, therapeutic modalities, as well as the morbidity and mortality related to thrombocytopenia in critical care.
Results: During the study period, and out of these 603 patients, 168 patients had thrombocytopenia, that is an incidence of 27.8%; 38 patients among them were admitted with an already ongoing thrombocytopenia. Sepsis, Acute respiratory distress syndrome, renal failure, hemodialysis, and liver dysfunction were risk factors of thrombocytopenia and predictors of mortality. Thrombocytopenia was a factor of increased mortality, the percentage of death was higher in the thrombocytopenic group compared with the non-thrombocytopenic group with a rate of 42.26%. However, it was not an independent factor of mortality.
Conclusion: Sepsis is the major factor incriminated in the occurrence of thrombocytopenia in critically ill patients. Therapeutic management including platelet transfusion should depend on the etiology of thrombocytopenia along with the associated hemorrhagic risk.
Keywords:
Thrombocytopenia, Intensive care, Sepsis, Platelet transfusion, Mortality
Article Details
How to Cite
BOU-OUHRICH, Yassine; CHARRA, Boubaker.
Thrombocytopenia in Critical Care Unit: Risk Factors, Etiologies, and Management.
Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3465>. Date accessed: 25 apr. 2024.
doi: https://doi.org/10.18103/mra.v10i12.3465.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2- Williamson DR, Lesur O, Tétrault JP, Nault V, Pilon D. Thrombocytopenia in the critically ill: prevalence, incidence, risk factors, and clinical outcomes. Canadian Journal of Anaesthesia = Journal Canadien D’anesthesie. 2013;60(7):641-651. doi:10.1007/s12630-013-9933-7
3- Lim SY, Jeon EJ, Kim HJ, et al. The Incidence, Causes, and Prognostic Significance of New-Onset Thrombocytopenia in Intensive Care Units: A Prospective Cohort Study in a Korean Hospital. Journal of Korean Medical Science. 2012;27(11):1418. doi:10.3346/jkms.2012.27.11.1418
4- Giustozzi M, Ehrlinder H, Bongiovanni D, et al. Coagulopathy and sepsis: Pathophysiology, clinical manifestations and treatment. Blood Reviews. Published online June 2021:100864. doi:10.1016/j.blre.2021.100864
5- STEPHAN F. Thrombopénies en réanimation. Réanimation. 2008;17(4):339-347. doi:10.1016/j.reaurg.2008.03.008
6- Williamson DR, Albert M, Heels-Ansdell D, et al. Thrombocytopenia in Critically Ill Patients Receiving Thromboprophylaxis. Chest. 2013;144(4):1207-1215. doi:10.1378/chest.13-0121
7- Lauzier F, Arnold DM, Rabbat C, et al. Risk factors and impact of major bleeding in critically ill patients receiving heparin thromboprophylaxis. Intensive Care Medicine. 2013;39(12):2135-2143. doi:10.1007/s00134-013-3044-3
8- Dalteparin versus Unfractionated Heparin in Critically Ill Patients. New England Journal of Medicine. 2011;364(14):1305-1314. doi:10.1056/nejmoa1014475
9- N M P Rahanitriniaina , T Razafindrainibe , S Rakotonomenjanahary , Aspects cliniques et évolutifs de la thrombopénie au service de Réanimation Chirurgicale du Centre Hospitalier Universitaire Antananarivo, Rev. Anesth.-Réanim. Med. Urg. Toxicol. 2019 (Janvier-Juin);11(1) : 1-4.
10- Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: Bleeding prevalence, transfusion requirements, and outcome*. Critical Care Medicine. 2002;30(8):1765-1771. doi:10.1097/00003246-200208000-00015
11- Vanderschueren S, De Weerdt A, Malbrain M, et al. Thrombocytopenia and prognosis in intensive care. Critical Care Medicine. 2000;28(6):1871-1876. doi:10.1097/00003246-200006000-00031
12- Vandijck DM, Blot SI, De Waele JJ, Hoste EA, Vandewoude KH, Decruyenaere JM. Thrombocytopenia and outcome in critically ill patients with bloodstream infection. Heart & Lung. 2010;39(1):21-26. doi:10.1016/j.hrtlng.2009.07.005
13- Marret E, Samama M. Thrombopénies en réanimation. Conférences d’actualisation de la Société Française d’Anesthésie Réanimation. Paris: Elsevier; 1998 (511-522).
14- Steéphan F, Hollande J, Richard O, Cheffi A, Maier-Redelsperger M, Flahault A. Thrombocytopenia in a Surgical ICU. Chest. 1999;115(5):1363-1370. doi:10.1378/chest.115.5.1363
15- Aissaoui Y, Benkabbou A, Alilou M, et al. La thrombopénie en réanimation chirurgicale: incidence, analyse des facteurs de risque et impact sur le pronostic. La Presse Médicale. 2007;36(1):43-49. doi:10.1016/j.lpm.2006.05.001
16- SLICHTER S. Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfusion Medicine Reviews. 2004;18(3):153-167. doi:10.1016/j.tmrv.2004.03.003
17- DeSancho MT, Rand JH. BLEEDING AND THROMBOTIC COMPLICATIONS IN CRITICALLY ILL PATIENTS WITH CANCER. Critical Care Clinics. 2001;17(3):599-622. doi:10.1016/s0749-0704(05)70200-1
18- Giustozzi M, Ehrlinder H, Bongiovanni D, et al. Coagulopathy and sepsis: Pathophysiology, clinical manifestations and treatment. Blood Reviews. Published online June 2021:100864. doi:10.1016/j.blre.2021.100864
19- Angus DC, van der Poll T. Severe Sepsis and Septic Shock. New England Journal of Medicine. 2013;369(9):840-851. doi:10.1056/nejmra1208623
20- Greinacher A, Selleng S. How I evaluate and treat thrombocytopenia in the intensive care unit patient. Blood. 2016;128(26):3032-3042. doi:10.1182/blood-2016-09-693655
21- Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: the past, present, and future. Hematology. 2017;2017(1):660-666. doi:10.1182/asheducation-2017.1.660
22- Zarychanski R, Abou-Setta A, Kanji S, et al. Efficacy and safety of heparin in patients with sepsis: a systematic review and meta-analysis. Critical Care. 2015;19(Suppl 1):P123. doi:10.1186/cc14203
23- La Rosée P. Treatment of hemophagocytic lymphohistiocytosis in adults. Hematology. 2015;2015(1):190-196. doi:10.1182/asheducation-2015.1.190
24- Rimmer E, Houston BL, Kumar A, et al. The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis. Critical Care. 2014;18(6). doi:10.1186/s13054-014-0699-2
25- Stéphan F, Cheffi MA, Kaplan C, et al. Autoantibodies against platelet glycoproteins in critically ill patients with thrombocytopenia. The American Journal of Medicine. 2000;108(7):554-560. doi:10.1016/s0002-9343(00)00332-6
26- Claushuis TAM, van Vught LA, Scicluna BP, et al. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood. 2016;127(24):3062-3072. doi:10.1182/blood-2015-11-680744
27- Conférence de consensus française en réanimation et médecine d’urgence (SRLF, GEHT, Groupe français de réanimation pédiatrique). Coagulations intravasculaires disséminées en réanimation : définition, classification et traitement (à l’exception des cancers et hémopathies malignes). Réanimation 2002;11:567–74.
28- B. François.CIVD et Sepsis, « www.srlf.org »,9 Sep 2011.
29- Gonzalez F, Vincent F, Cohen Y. Syndrome d’activation macrophagique d’origine infectieuse : étiologies et prise en charge. Réanimation. 2009;18(4):284-290. doi:10.1016/j.reaurg.2009.03.002
30- Coppo P. Microangiopathies thrombotiques secondaires. La Revue de Médecine Interne. 2017;38(11):731-736. doi:10.1016/j.revmed.2017.06.025
31- Christiansen CF, Bahmanyar S, Ghanima W, et al. Chronic immune thrombocytopenia in Denmark, Sweden and Norway: The Nordic Country Patient Registry for Romiplostim. EClinicalMedicine. 2019;14:80-87. doi:10.1016/j.eclinm.2019.07.015
32- Weycker D, Hanau A, Hatfield M, et al. Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis. Journal of Medical Economics. Published online October 9, 2019:1-9. doi:10.1080/13696998.2019.1669329
33- Cines DB, Blanchette VS. Immune Thrombocytopenic Purpura. New England Journal of Medicine. 2002;346(13):995-1008. doi:10.1056/nejmra010501
34- Bousserouit M, Hakkou F, Chbicheb S. Oral Manifestations of Immune Thrombocytopenic Purpura. Integrative Journal of Medical Sciences. Published online 2021. doi:10.15342/ijms.2022.444
35- Rutherford CJ, Frenkel EP. Thrombocytopenia: Issues in Diagnosis and Therapy. Medical Clinics of North America. 1994;78(3):555-575. doi:10.1016/s0025-7125(16)30147-x
36- Carey PJ. Drug-Induced Myelosuppression. Drug Safety. 2003;26(10):691-706. doi:10.2165/00002018-200326100-00003
37- Visentin GP, Liu CY. 9. Drug Induced Thrombocytopenia. Hematology/oncology clinics of North America. 2007;21(4):685-vi. doi:10.1016/j.hoc.2007.06.005
38- Saif MW, McGee PJ. Hemolytic-uremic syndrome associated with gemcitabine: a case report and review of literature. JOP. 2005 Jul 8;6(4):369-74. PMID: 16006690.
39- Arepally GM, Ortel TL. Heparin-Induced Thrombocytopenia. Annual Review of Medicine. 2010;61(1):77-90. doi:10.1146/annurev.med.042808.171814
40- Spahn DR, Rossaint R. Coagulopathy and blood component transfusion in trauma. British Journal of Anaesthesia. 2005;95(2):130-139. doi:10.1093/bja/aei169
41- E. Marret , M. Ohana. Gestion d’une thrombopénie en anesthésie, Conférences d’actualisation 2006, p. 95-112.
42- Mumtaz H, Williams V, Hauer-Jensen M, et al. Central venous catheter placement in patients with disorders of hemostasis. American Journal of Surgery. 2000;180(6):503-505; discussion 506. doi:10.1016/s0002-9610(00)00552-3
43- Cawley MJ, Wittbrodt ET, Boyce EG, Skaar DJ. Potential Risk Factors Associated with Thrombocytopenia in a Surgical Intensive Care Unit. Pharmacotherapy. 1999;19(1):108-113. doi:10.1592/phco.19.1.108.30518
44- Duayer IF, Araújo MJCLN, Nihei CH, et al. Dialysis-related thrombocytopenia: a case report. Brazilian Journal of Nephrology. 2022;44(1):116-120. doi:10.1590/2175-8239-jbn-2020-0109
45- Hardy JF, de Moerloose P, Samama M. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Canadian Journal of Anesthesia. 2004;51(4):293-310. doi:10.1007/bf03018233
46- Bulger EM. Fat Embolism Syndrome. Archives of Surgery. 1997;132(4):435. doi:10.1001/archsurg.1997.01430280109019
47- Valent A, Delmotte PR, Lebrun M, Fohlen B, Champigneulle B. Le syndrome d’embolie graisseuse : une cause rare mais classique de purpura pétéchial chez un polytraumatisé. Anesthésie & Réanimation. 2019;5(6):524-527. doi:10.1016/j.anrea.2019.04.009
48- Warner P, Fields AL, Braun LC, et al. Thrombocytopenia in the Pediatric Burn Patient. Journal of Burn Care & Research. 2011;32(3):410-414. doi:10.1097/bcr.0b013e318217f91b
49- Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood. 2017;130(21):2271-2277. doi:10.1182/blood-2017-05-781971
50- Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168-186. doi:10.1182/blood-2009-06-225565
51- Schaal JV, Fischer C, Boyer K, Mercier FJ. Thrombopénie et grossesse. Le Praticien en Anesthésie Réanimation. 2012;16(6):323-334. doi:10.1016/j.pratan.2012.07.007
52- Frédéric Pène, Nadine Ajzenberg, Thrombopénie en réanimation : démarche diagnostique, « www.srlf.org »,16 août 2011.
53- Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign. Critical Care Medicine. 2017;45(3):486-552. doi:10.1097/ccm.0000000000002255
54- Abrams D, Baldwin MR, Champion M, et al. Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: a cohort study. Intensive Care Medicine. 2016;42(5):844-852. doi:10.1007/s00134-016-4312-9
55- Ning S, Barty R, Liu Y, Heddle NM, Rochwerg B, Arnold DM. Platelet Transfusion Practices in the ICU: Data From a Large Transfusion Registry. CHEST. 2016;150(3):516-523. doi:10.1016/j.chest.2016.04.004
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