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Let's start with #thrombocytopenia in the ICU #chestcritcare
#thrombocytopenia is very common in the ICU, with 67% patients having it at admission to ICU and about 46% patients developing it at some point in their ICU stay https://link.springer.com/chapter/10.1007/978-3-030-26710-0_83
Patients who develop #thrombocytopenia in the ICU have higher need for vasoactive infusions, more organ dysfunction and, after adjusting for confouding factors, increased risk of death. https://pubmed.ncbi.nlm.nih.gov/21071526/
The evaluation of #thrombocytopenia in the ICU is very challenging, since it is both common and frequently multifactorial. A structured approach in the evalaution is essential:
1. Is it true #thrombocytopenia (smear to look for clumps); 2. Is the patient bleeding; 3. Consider a thrombotic microangiopathy: MAHA, TTP, DIC (again a smear is your friend); 4. Review all medications - not only heparin will cause thrombocytopenia; 5. Evaluate for infections
6. Consider hemodilution (massive transfusion, too much crystaloid); 7. Evaluate for support devices that can cause mechanical shearing https://link.springer.com/chapter/10.1007/978-3-030-26710-0_83
Addressing the cause of the #thrombocytopenia should be the priority. The recommendation for platelet transfusion in the ICU is not strong, but a threshold of 50000 platelets before perfoming procedures is supported by the AABB https://pubmed.ncbi.nlm.nih.gov/25383671/
More on heme/onc-critical care tomorrow, friends. Share with us what your approach to #thrombocytopenia in the ICU is #chestcritcare
