Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 2:4:24.
doi: 10.1186/s13613-014-0024-x. eCollection 2014.

Mechanisms and etiologies of thrombocytopenia in the intensive care unit: impact of extensive investigations

Nadiejda Antier  1 , Jean-Pierre Quenot  2 , Jean-Marc Doise  1 , Robin Noel  1 , Emmanuel Demaistre  3 , Hervé Devilliers  4
Affiliations

Mechanisms and etiologies of thrombocytopenia in the intensive care unit: impact of extensive investigations

Nadiejda Antier et al. Ann Intensive Care. .

Abstract

Background: Thrombocytopenia 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.

Methods: Before-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.

Results: In 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).

Conclusions: Systematic and extensive investigation using routine tests highlights the mechanisms and etiology of thrombocytopenia in most cases.

Keywords: Bone marrow aspiration; Intensive care unit; Thrombocytopenia.

PubMed Disclaimer

References

    1. Priziola JL, Smythe MA, Dager WE. Drug-induced thrombocytopenia in critically ill patients. Crit Care Med. 2010;38:S145–S154. - PubMed
    1. Strauss R, Wehler M, Mehler K, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med. 2002;30:1765–1771. - PubMed
    1. Akca S, Haji-Michael P, de Mendonca A, Suter P, Levi M, Vincent JL. Time course of platelet counts in critically ill patients. Crit Care Med. 2002;30:753–756. - PubMed
    1. Moreau D, Timsit JF, Vesin A, Garrouste-Orgeas M, de Lassence A, Zahar J-R, Adrie C, Vincent F, Cohen Y, Schlemmer B, Azoulay E. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest. 2007;131:1735–1741. - PubMed
    1. Stephan F, Montblanc J, Cheffi A, Bonnet F. Thrombocytopenia in critically ill surgical patients: a case-control study evaluating attributable mortality and transfusion requirements. Crit Care. 1999;3:151–158. - PMC - PubMed

LinkOut - more resources