Log in | Register

Epidemiology and outcome of thrombocytopenic patients in the intensive care unit: results of a prospective multicenter study

Fabrice Thiolliere| Anne Françoise Serre-Sapin| Jean Reignier| Marcel Benedit| Jean Michel Constantin| Christine Lebert| Dominique Guélon| Jean François Timsit| Bertrand Souweine
Original
Volume 39, Issue 8 / August , 2013

Pages 1460 - 1468

Abstract

Purpose

To assess the epidemiology of intensive care unit (ICU) patients with thrombocytopenia (TP).

Methods

All consecutive ICU-admitted patients with TP either on admission or acquired during ICU stay were included. TP was defined as either absolute (platelet count <100 × 109/L) or relative (decrease in the platelet count >30 %). Extensive diagnostic workup of TP including bone marrow aspiration was performed.

Results

Absolute TP was diagnosed in 208 patients and relative TP in 93. In six patients (2 %), no cause of TP was identified. The median number of TP etiologies per patient was two, with sepsis being the leading cause. Bone marrow aspirates were analyzed in 238 patients. They showed a normal megakaryocyte number in 221 (93 %) and provided novel information for diagnosis in 52 (22 %). Results were susceptible to having an impact on patient management in 22 cases (11 %). The frequency of bone marrow aspiration with results susceptible to having an impact on management did not differ between patients with and without disseminated intravascular coagulation (P = 0.22) and with and without sepsis/septic shock (P = 0.7) but was significantly lower in patients with relative TP than in those with absolute TP (P < 0.01). A serious bleeding event was observed in 30 patients (14.9 %) and a nadir platelet count below 50 × 109/L was an independent risk factor (P < 0.05).

Conclusions

In thrombocytopenic patients, sepsis is the leading cause of TP. Bone marrow aspirates may yield significant information on TP mechanisms and contribute to the subsequent management of patients, especially those with absolute TP.

Keywords

References

  1. Vicente Rull JR, Loza Aguirre J, de la Puerta E, Moreno Millan E, Peñas Maldonado L, Perez Clausell C (1984) Thrombocytopenia induced by pulmonary artery flotation catheters. A prospective study. Intensive Care Med 10:29–31
  2. Vonderheide RH, Thadhani R, Kuter DJ (1998) Association of thrombocytopenia with the use of intra-aortic balloon pumps. Am J Med 105:27–32
    • View reference on PubMed
    • View reference on publisher's website
  3. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, Bobbaers H (2000) Thrombocytopenia and prognosis in intensive care. Crit Care Med 28:1871–1876
    • View reference on PubMed
    • View reference on publisher's website
  4. Akca S, Haji-Michael P, De Mendonça A, Suter P, Levi M, Vincent JL (2002) Time course of platelet counts in critically ill patients. Crit Care Med 30:753–756
    • View reference on PubMed
    • View reference on publisher's website
  5. Shalansky SJ, Verma AK, Levine M, Spinelli JJ, Dodek PM (2002) Risk markers for thrombocytopenia in critically ill patients: a prospective analysis. Pharmacotherapy 22:803–813
    • View reference on PubMed
    • View reference on publisher's website
  6. Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG (2002) Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med 30:1765–1771
    • View reference on PubMed
    • View reference on publisher's website
  7. Crowther MA, Cook DJ, Meade MO, Griffith LE, Guyatt GH, Arnold DM, Rabbat CG, Geerts WH, Warkentin TE (2005) Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care 20:348–353
    • View reference on PubMed
    • View reference on publisher's website
  8. Brogly N, Devos P, Boussekey N, Georges H, Chiche A, Leroy O (2007) Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. J Infect 55:136–140
    • View reference on PubMed
    • View reference on publisher's website
  9. Sharma B, Sharma M, Majumder M, Steier W, Sangal A, Kalawar M (2007) Thrombocytopenia in septic shock patients—a prospective observational study of incidence, risk factors and correlation with clinical outcome. Anaesth Intensive Care 35:874–880
    • View reference on PubMed
  10. Caruso P, Ferreira AC, Laurienzo CE, Titton LN, Terabe DSM, Carnieli DS, Deheinzelin D (2010) Short- and long-term survival of patients with metastatic solid cancer admitted to the intensive care unit: prognostic factors. Eur J Cancer Care (Engl) 19:260–266
    • View reference on publisher's website
  11. Vandijck DM, Blot SI, De Waele JJ, Hoste EA, Vandewoude KH, Decruyenaere JM (2010) Thrombocytopenia and outcome in critically ill patients with bloodstream infection. Heart Lung 39:21–26
    • View reference on PubMed
    • View reference on publisher's website
  12. Baughman RP, Lower EE, Flessa HC, Tollerud DJ (1993) Thrombocytopenia in the intensive care unit. Chest 104:1243–1247
    • View reference on PubMed
    • View reference on publisher's website
  13. Bonfiglio MF, Traeger SM, Kier KL, Martin BR, Hulisz DT, Verbeck SR (1995) Thrombocytopenia in intensive care patients: a comprehensive analysis of risk factors in 314 patients. Ann Pharmacother 29:835–842
    • View reference on PubMed
  14. Chakraverty R, Davidson S, Peggs K, Stross P, Garrard C, Littlewood TJ (1996) The incidence and cause of coagulopathies in an intensive care population. Br J Haematol 93:460–463
    • View reference on PubMed
    • View reference on publisher's website
  15. Hanes SD, Quarles DA, Boucher BA (1997) Incidence and risk factors of thrombocytopenia in critically ill trauma patients. Ann Pharmacother 31:285–289
    • View reference on PubMed
  16. Cawley MJ, Wittbrodt ET, Boyce EG, Skaar DJ (1999) Potential risk factors associated with thrombocytopenia in a surgical intensive care unit. Pharmacotherapy 19:108–113
    • View reference on PubMed
    • View reference on publisher's website
  17. Stéphan F, Hollande J, Richard O, Cheffi A, Maier-Redelsperger M, Flahault A (1999) Thrombocytopenia in a surgical ICU. Chest 115:1363–1370
    • View reference on PubMed
    • View reference on publisher's website
  18. Ben Hamida C, Lauzet J-Y, Rézaiguia-Delclaux S, Duvoux C, Cherqui D, Duvadelstin P, Stephan F (2003) Effect of severe thrombocytopenia on patient outcome after liver transplantation. Intensive Care Med 29:756–762
    • View reference on PubMed
  19. Salman SS, Fernández Pérez ER, Stubbs JR, Gajic O (2007) The practice of platelet transfusion in the intensive care unit. J Intensive Care Med 22:105–110
    • View reference on PubMed
    • View reference on publisher's website
  20. Cherif H, Martling C-R, Hansen J, Kalin M, Björkholm M (2007) Predictors of short and long-term outcome in patients with hematological disorders admitted to the intensive care unit for a life-threatening complication. Support Care Cancer 15:1393–1398
    • View reference on PubMed
    • View reference on publisher's website
  21. Hui P, Cook DJ, Lim W, Fraser GA, Arnold DM (2011) The frequency and clinical significance of thrombocytopenia complicating critical illness: a systematic review. Chest 139:271–278
    • View reference on PubMed
    • View reference on publisher's website
  22. Stephan F, Montblanc JD, Cheffi A, Bonnet F (1999) Thrombocytopenia in critically ill surgical patients: a case-control study evaluating attributable mortality and transfusion requirements. Crit Care 3:151–158
    • View reference on PubMed
    • View reference on publisher's website
  23. Martin CM, Priestap F, Fisher H et al (2009) A prospective, observational registry of patients with severe sepsis: the Canadian Sepsis Treatment and Response Registry. Crit Care Med 37:81–88
    • View reference on PubMed
    • View reference on publisher's website
  24. Moreau D, Timsit J-F, Vesin A, Garrouste-Orgeas M, de Lassence A, Zahar J-R, Adrie C, Vincent F, Cohen Y, Schlemmer B, Azoulay E (2007) Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest 131:1735–1741
    • View reference on PubMed
    • View reference on publisher's website
  25. Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A (2006) Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 4:759–765
    • View reference on PubMed
    • View reference on publisher's website
  26. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709
    • View reference on PubMed
    • View reference on publisher's website
  27. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent J-L, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med 29:530–538
    • View reference on PubMed
  28. Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M (2001) Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 86:1327–1330
    • View reference on PubMed
  29. Sivula M, Tallgren M, Pettilä V (2005) Modified score for disseminated intravascular coagulation in the critically ill. Intensive Care Med 31:1209–1214
  30. George JN, Raskob GE, Shah SR, Rizvi MA, Hamilton SA, Osborne S, Vondracek T (1998) Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Intern Med 129:886–890
    • View reference on PubMed
    • View reference on publisher's website
  31. Janka GE (2005) Hemophagocytic lymphohistiocytosis. Hematology 10(Suppl 1):104–107
    • View reference on PubMed
    • View reference on publisher's website
  32. Schols SEM, Heemskerk JWM, Van Pampus ECM (2010) Correction of coagulation in dilutional coagulopathy: use of kinetic and capacitive coagulation assays to improve hemostasis. Transfus Med Rev 24:44–52
    • View reference on PubMed
    • View reference on publisher's website
  33. Louwes H, Zeinali Lathori OA, Vellenga E, de Wolf JT (1999) Platelet kinetic studies in patients with idiopathic thrombocytopenic purpura. Am J Med 106:430–434
    • View reference on PubMed
    • View reference on publisher's website
  34. François B, Trimoreau F, Vignon P, Fixe P, Praloran V, Gastinne H (1997) Thrombocytopenia in the sepsis syndrome: role of hemophagocytosis and macrophage colony-stimulating factor. Am J Med 103:114–120
    • View reference on PubMed
    • View reference on publisher's website
  35. Buyse S, Teixeira L, Galicier L, Mariotte E, Lemiale V, Seguin A, Bertheau P, Canet E, de Labarthe A, Darmon M, Rybojad M, Schlemmer B, Azoulay E (2010) Critical care management of patients with hemophagocytic lymphohistiocytosis. Intensive Care Med 36:1695–1702
  36. Wickramasinghe SN (2006) Diagnosis of megaloblastic anaemias. Blood Rev 20:299–318
    • View reference on PubMed
    • View reference on publisher's website
  37. Andrès E, Affenberger S, Zimmer J, Vinzio S, Grosu D, Pistol G, Maloisel F, Weitten T, Kaltenbach G, Blicklé J-F (2006) Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency. Clin Lab Haematol 28:50–56
    • View reference on PubMed
    • View reference on publisher's website
  38. Mavrommatis AC, Theodoridis T, Orfanidou A, Roussos C, Christopoulou-Kokkinou V, Zakynthinos S (2000) Coagulation system and platelets are fully activated in uncomplicated sepsis. Crit Care Med 28:451–457
    • View reference on PubMed
    • View reference on publisher's website
  39. Yeaman MR (2010) Platelets in defense against bacterial pathogens. Cell Mol Life Sci 67:525–544
    • View reference on PubMed
    • View reference on publisher's website
  40. Van der Linden T, Souweine B, Dupic L, Soufir L, Meyer P (2012) Management of thrombocytopenia in the ICU (pregnancy excluded). Ann Intensive Care 2:42–47
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement