Thrombocytopenia in the intensive care unit patient.

@article{Greinacher2010ThrombocytopeniaIT,
  title={Thrombocytopenia in the intensive care unit patient.},
  author={Andreas Greinacher and Kathleen Selleng},
  journal={Hematology. American Society of Hematology. Education Program},
  year={2010},
  volume={2010},
  pages={
          135-43
        }
}
  • A. Greinacher, K. Selleng
  • Published 4 December 2010
  • Medicine
  • Hematology. American Society of Hematology. Education Program
The many comorbidities in the severely ill patient also make thrombocytopenia very common (∼40%) in intensive care unit patients. The risk of bleeding is high with severe thrombocytopenia and is enhanced in intensive care patients with mild or moderately low platelet counts when additional factors are present that interfere with normal hemostatic mechanisms (eg, platelet function defects, hyperfibrinolysis, invasive procedures, or catheters). Even if not associated with bleeding, low platelet… 
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There are strong evidences available that delay in platelet count restoration in ICU patients is an indicator of a bad outcome and absolute platelet number alone does not provide sufficient data in characterizing thrombocytopenia in ICu patients.
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A practical approach based on the authors' experience is described to guide management of a critically ill patient who develops thrombocytopenia and the risk‐benefit of prophylactic platelet transfusions in this setting is uncertain.
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This chapter presents an algorithm for determining the likelihood of these respective causes that takes into account the severity of thrombocytopenia, its timing of onset with respect to exposure to drugs and transfusions, the pace of the fall in platelet count, and the presence ofThrombosis or hemorrhage.
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A stepwise approach where testing for anti-PF4/H antibodies is performed only in patients with typical clinical symptoms of HIT improves diagnostic specificity of the laboratory assays without losing sensitivity, thereby helping to avoid overdiagnosis and resulting HIT overtreatment.
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Most prophylactic platelet transfusions were given using thresholds of 10–20 × 109/L in critically ill thrombocytopenic cancer patients, and neither low admission platelet count nor low nadir platelet counts were predictive of ICU-acquired bleeding.
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Severe thrombocytopenia could be mentioned as a poor prognostic factor for increased mortality and prolonged hospitalization period in ICU patients and platelet might be considered as a prognosis monitor inICU settings.
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A high severity of illness, prior surgery, use of inotropes or vasopressors, renal replacement therapy, and liver dysfunction are associated with a higher risk of thrombocytopenia developing in the ICU, whereas LMWHThromboprophylaxis isassociated with a lower risk.
Haematological problems in intensive care
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