Skip to main content
The Egyptian Journal of Bronchology
Download PDF
  • Original article
  • Open access
  • Published:

Assessment of thrombocytopenia in critically ill patients

Egyptian Journal of Bronchology volume 8, pages 143–148 (2014)Cite this article

Abstract

Background

Thrombocytopenia is commonly observed among critically ill patients.

Aim

The aim of this study was to evaluate the incidence, risk factors, and the outcome of thrombocytopenia in patients admitted to the respiratory intensive care unit (RICU).

Materials and methods

Data were collected from 50 adult patients admitted to the RICU in a 6-month period. The baseline platelet count was measured and was repeated every other day during the RICU stay period. Thrombocytopenia was defined as platelet count of less than 150´109/l.

Results

The incidence of thrombocytopenia was 20% (10 patients). The overall mortality was 16%, of which 50% of the patients were having thrombocytopenia. The thrombocytopenic group had a higher mortality (40 vs. 10%, P < 0.05), a lower admission platelet count (215.3 ± 85.6 vs. 252.8 ± 73.2, P < 0.05), a lower nadir platelet count (111.1 ± 22.6 vs. 213.9 ± 53.2, P < 0.001), an increased transfusion requirement (30 vs. 2.5%, P < 0.05), and increased septic shock (40 vs. 2.5%, P < 0.05) compared with the nonthrombocytopenic group. Comorbidities, indications for RICU admission, the length of RICU stay, mechanical ventilation, days on mechanical ventilation, admission severity scores, bleeding, ICU-related complications, and medications administrated during the RICU stay did not differ significantly. A prolonged RICU stay of more than 15 days carried a 4.7 times higher incidence of development of thrombocytopenia. Thrombocytopenia differed significantly between survivors and nonsurvivors (P < 0.05), with a significant effect on mortality (P = 0.034).

Conclusion

Thrombocytopenia is common among critically ill patients and affects the mortality significantly. Prolonged ICU stay and septic shock are among the risk factors for thrombocytopenia. Egypt J Broncho 8:143–148

References

  1. Baughman RP, Lower EE, Flessa HC, et al. Thrombocytopenia in the intensive care unit. Chest 1993; 104:1243–1247.

    Article  CAS  Google Scholar 

  2. Bonfiglio MF, Traeger SM, Kier KL, et al. Thrombocytopenia in intensive care patients: a comprehensive analysis of risk factors in 314 patients. Ann Pharmacother 1995; 29:835–842.

    Article  CAS  Google Scholar 

  3. Vanderschueren S, De Weerdt A, Malbrain M, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med 2000; 28:1871–1876.

    Article  CAS  Google Scholar 

  4. Strauss R, Wehler M, Mehler K, et al. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med 2002; 30:1765–1771.

    Article  Google Scholar 

  5. Stephan F, Hollande J, Richard O, et al. Thrombocytopenia in a surgical ICU. Chest 1999; 115:1363–1370.

    Article  CAS  Google Scholar 

  6. Hui P, Cook DJ, Lim W, et al. The frequency and clinical significance of thrombocytopenia complicating critical illness: a systematic review. Chest 2011; 139:271–278.

    Article  Google Scholar 

  7. Akca S, Haji-Michael P, de Mendonça A, et al. Time course of platelet counts in critically ill patients. Crit Care Med 2002; 30:753–756.

    Article  Google Scholar 

  8. Shalansky SJ, Verma AK, Levine M, et al. Risk markers for thrombocytopenia in critically ill patients: a prospective analysis. Pharmacotherapy 2002; 22:803–813.

    Article  Google Scholar 

  9. Crowther MA, Cook DJ, Meade MO, et al. Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care 2005; 20:348–353.

    Article  Google Scholar 

  10. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818–829.

    Article  CAS  Google Scholar 

  11. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996; 22:707–710.

    Article  CAS  Google Scholar 

  12. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963.

    Article  Google Scholar 

  13. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23:1638–1652.

    Article  CAS  Google Scholar 

  14. Agrawal S, Sachdev A, Gupta D, et al. Platelet counts and outcome in the pediatric intensive care unit. Indian J Crit Care Med 2008; 12:102–108.

    Article  Google Scholar 

  15. Lim SY, Jeon EJ, Kim HJ, et al. The incidence, causes, and prognostic significance of new-onset thrombocytopenia in intensive care units, a prospective cohort study in a Korean hospital. J Korean Med Sci 2012; 27:1418–1423.

    Article  Google Scholar 

  16. Kurian S, Mehta A, Shibli MH. Prognostic power of thrombocytopenia in critically ill patients. Chest 2009; 136:28S.

    Article  Google Scholar 

  17. Platelet transfusion therapy. JAMA 1987; 257:1777–1780.

  18. Beutler E. Platelet transfusions: the 20 000/microL trigger. Blood 1993; 81:1411–1413.

    Article  CAS  Google Scholar 

  19. Eldor A, Avitzour M, Or R, et al. Prediction of haemorrhagic diathesis in thrombocytopenia by mean platelet volume. Br Med J 1982; 285:397–400.

    Article  CAS  Google Scholar 

  20. Cawley MJ, Wittbrodt ET, Boyce EG, et al. Potential risk factors associated with thrombocytopenia in a surgical intensive care unit. Pharmacotherapy 1999; 19:108–113.

    Article  CAS  Google Scholar 

  21. Bogdonoff D, Williams M, Stone D. Thrombocytopenia in the critically ill patient. J Crit Care 1990; 3:186–205.

    Article  Google Scholar 

  22. Warkentin TE, Cook RJ, Marder VJ, et al. Anti-platelet factor 4/heparin antibodies in orthopedic surgery patients receiving antithrombotic prophylaxis with fondaparinux or enoxaparin. Blood 2005; 106:3791–3796.

    Article  CAS  Google Scholar 

  23. Sprung CL, Peduzzi PN, Shatney CH, et al. Impact of encephalopathy on mortality in the sepsis syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group. Crit Care Med 1990; 18:801–806.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest Diseases, Ain Shams University, Egypt

    Mohammad A. Faramawy & Iman H. Galal MD, PhD

  2. Abbassia Chest Hospital, Cairo, Egypt

    Asmaa M. Elasser

Authors
  1. Mohammad A. Faramawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iman H. Galal MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asmaa M. Elasser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iman H. Galal MD, PhD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Faramawy, M.A., Galal, I.H. & Elasser, A.M. Assessment of thrombocytopenia in critically ill patients. Egypt J Bronchol 8, 143–148 (2014). https://doi.org/10.4103/1687-8426.145712

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.145712

Keywords