A Comprehensive Review of Thrombocytopenia With a Spotlight on Intensive Care Patients

Abstract

Thrombocytopenia is a common entity seen in ICU patients and is associated with increased morbidity such as bleeding and transfusions, and mortality in ICU patients. Various mechanisms such as decreased platelet production, sequestration, destruction, consumption, and sometimes a combination of these factors contribute to thrombocytopenia. An understanding of the mechanism is essential to diagnose the cause of thrombocytopenia and to help provide appropriate management. The management strategies are aimed at treating the underlying disorder, such as platelet transfusion to treat complications like bleeding. Several studies have aimed to provide the threshold for platelet transfusions in various clinical settings and recommend a conservative approach in the appropriate scenario. In this review, we discuss various pathophysiological mechanisms of thrombocytopenia and the diverse scenarios of thrombocytopenia encountered in the ICU setting to shed light on the varied thresholds for platelet transfusion, alternative agents to platelet transfusion, and future directions for the implementation of thromboelastography (TEG) in multiple clinical scenarios to assist in the administration of appropriate blood products to correct coagulopathy.

Keywords: drug-induced thrombocytopenia; immune-mediated thrombocytopenia; post-operative thrombocytopenia; pregnancy-induced thrombocytopenia; sepsis induced thrombocytopenia; thrombocytopenia; thromboelastography (teg); thrombotic thrombocytopenia syndrome; thrombotic thrombocytopenic thrombocytopenia; transfusion practices.

Figure 1. HIT diagnosis algorithm as per American Society of Hematology 2018 guidelines

HIT: Heparin-induced thrombocytopenia

Figure 2. DIC diagnosis score

≥ 5 points: compatible with overt DIC, repeat scoring daily < 5 points: suggestive of non-overt DIC, repeat scoring within the next one to two days DIC: Disseminated intravascular coagulation

Figure 3. Thromboelastography parameters.

R: Reaction time, K: K-time/Kinetics, A/α: Alpha angle, MA: Maximum amplitude, A_30: Amplitude at 30 minutes after the beginning of the test Contributed by Mikael Häggström, Creative Commons Attribution 4.0 International License.