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Thrombocytopenia in the critically ill 

Thrombocytopenia in the critically ill
Chapter:
Thrombocytopenia in the critically ill
Author(s):

Jaimal Kothari

and Marie Scully

DOI:
10.1093/med/9780199600830.003.0272
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date: 21 February 2020

Thrombocytopenia is an extremely common finding in patients in intensive care. This can lead to serious morbidity and mortality from bleeding, and also uncertainty with regards to how to assess this risk in the wider context of the underlying pathology, which may be multifactorial, when specific blood products should be transfused, and the associated risks of carrying out interventional procedures. Haemodilution, platelet consumption, increased platelet destruction, reduced production, and increased sequestration are the main mechanisms that account for thrombocytopenia, and in the ICU setting there is typically an interplay of more than one of these that accounts for the counts seen. Sepsis and disseminated intravascular coagulation are the most common causes of thrombocytopenia in the ICU, with significant overlap between the pathologies. Less common causes in an intensive care unit setting include heparin-induced thrombocytopenia (HIT) and thrombotic thromobocytopenic purpura (TTP). The evidence base surrounding platelet thresholds remains poor and is an active area of research. Anticoagulation in the context of thrombocytopenia is problematic and requires a patient-specific approach.

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