Thrombocytopenia in the intensive care unit

The article was written by Doctor Nguyen Ngoc Phuong Nam - Emergency Department - Vinmec Central Park International General Hospital

Blood platelets are non-nucleated cells that travel in the blood stream and are produced in the bone marrow from Megakaryocytes. Platelets function in the body's hemostasis process. Low platelets can cause bleeding.

Mean diameter is 2.5 μm Peripheral blood platelet count 150-400 x 109/L Average life of platelets 8-10 days When mobilization is required for hemostasis, platelets are inherited from spleen into circulation (70% of total platelets)

There are many causes of thrombocytopenia:
Cause of dilution Due to the initial resuscitation infusion in hemorrhagic shock, there is a lot of blood loss.
Consumption of platelets Severe trauma: Platelets will mobilize to the injured area and increase consumption in wounds Disseminated intravascular coagulation (DIC): causes of DIC such as hemorrhagic shock, septic shock, burns... Platelets are sucked into microscopic clots in the intravascular lumen Severe sepsis: Platelet consumption will increase when the patient has severe infection, fever and risk of disseminated intravascular coagulation. . Due to the use of extracorporeal circulation devices such as: ECMO, continuous dialysis.... platelet cells will adhere to the membrane of the filter, causing thrombocytopenia. Platelets are captured and destroyed in organs other than blood Cirrhotic diseases, hypersplenism cause more platelets to be captured and destroyed in the spleen than normal.
Decreased platelet production Diseases such as cirrhosis, bone marrow failure, cancer, infections (HIV, HCV, EBV, CMV) cause a decrease in platelet production in the bone marrow leading to thrombocytopenia in the blood.
Destruction of platelets Diseases such as hemorrhagic disease, immune thrombocytopenia (ITP), Heparin-induced thrombocytopenia (HIT) causes increased destruction of platelets leading to thrombocytopenia in the blood
Microthrombotic disease TTP, TMA , HUS, HELP in these diseases appear microthrombus in the blood vessel that will attract platelets to this thrombus causing thrombocytopenia in the blood.
After blood transfusion A small percentage of blood products after transfusion will have thrombocytopenia in the blood.

Finding the cause of thrombocytopenia is very important in guiding treatment
Treating the underlying cause of thrombocytopenia such as: fever, infection, acute blood loss... will lead to recovery. platelet count in the blood.
If thrombocytopenia causes a high risk of bleeding when the platelet count is < 20x 109/L, or if bleeding is dangerous, then a platelet concentrate transfusion will be prescribed by the doctor. Except for a few diseases that are contraindicated for platelet transfusion such as: TTP, TMA, platelet transfusions should not be given because transfusion will cause more severe disease.
In addition, drugs may be used only to prevent platelet destruction or to increase platelet production in certain diseases.
For diseases that cause a decrease in platelet production due to blood cancer, cancer treatment is important because when the disease goes away, platelets will be produced in the same amount as normal people.
Therefore, thrombocytopenia is a common and dangerous disease during treatment in the ICU, so it is important to provide information about the medical history as well as find the cause of thrombocytopenia to make an appropriate treatment decision. for patients.
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