In this series of 147 patients, 52 thrombocytopenic (THR+) patients (35%) had a platelet count of < 100,000/mm during their ICU stay. The mean platelet count of the nonthrombocytopenic (THR—) patients was 232,000 ± 10,000/mm. Thrombocytopenia occurred 1.8 ± 0.5 days (range, 0 to 22) after ICU admission, with a mean platelet count at the time of diagnosis of 68,900 ± 3,000/mm. The frequency of thrombocytopenia according to its severity is shown in Figure 1. The mean nadir platelet count was 52,600 ± 3,800/mm, and there was no association between underlying illness and the severity of thrombocytopenia.
Platelet transfusions were performed in 13 patients who had a mean platelet count of 23,800 ± 4,900/mm; seven of them had a platelet count below 20,000/mm, and 10 had evidence of DIC. The reason for platelet transfusion was active bleeding in seven, emergency surgery in two, and risk of bleeding complication in the immediate postoperative period in one patient. Three patients with active bleeding in the postoperative period recovered after replacement of blood components. Among the 10 patients with DIC who received platelet transfusion, five survived and five died. online antibiotics
The platelet count rose to > 40,000 to 50,000/ mm several hours after platelet transfusion, but never > 100,000/mm. Platelet transfusion alone therefore did not allow complete correction of thrombocytopenia. Thrombocytopenia was corrected within 3.7 ± 0.5 days (range, 1 to 11) in 28 patients; reversal of thrombocytopenia did not differ according to the underlying disease.
Main reasons for ICU admission included 45 postoperative cases (orthopedic surgery, 16; thoracic and vascular surgery, 13; abdominal surgery, 8; other surgery, 8); 28 cases of shock (cardiogenic, septic, or undetermined); 20 cases of GI hemorrhage; 17 cases of trauma; 16 cases of acute respiratory failure; 15 cases of neurologic disorders; and 6 miscellaneous causes.
At the time of thrombocytopenia, main diagnoses included 21 cases of sepsis (8 cases of pneumonia, 5 cases of peritonitis, 2 cases of acute mesenteric ischemia, 2 intra-abdominal abscesses, 2 cases of biliary or urinary tract infection, 1 prosthetic joint infection, and 1 vascular prosthetic graft infection); 20 cases of postoperative bleeding or GI hemorrhage; and 11 miscellaneous causes.
Figure 1. Distribution of thrombocytopenia according to its severity, showing thrombocytopenia-related mortality. Open bars = survivors; solid bars = nonsurvivors