The platelet count and its implications in sickle cell disease patients admitted for intensive care

Abstract

Background and Aims:In sickle cell disease (SCD) patients admitted for intensive care, evaluation of platelet counts in different types of sickle cell complications and its prognostic relevance are not well-studied. Illuminating these aspects were the objectives of this study.Materials and Methods:A chart review of 136 adult SCD patients consecutively admitted to our Intensive Care Unit (ICU) was done. The prognosis on day 1 was assessed by Acute Physiology and Chronic Health Evaluation (APACHE II) and multiple organ dysfunction scores (MODS). Receiver operating characteristic (ROC) curves evaluated the ability of platelet counts, MODS, and APACHE II scores to predict survival.Results:The most common types of crises were severe pain (n = 53), acute chest syndrome (n = 40), and infection (n = 18); 17 patients were nonsurvivors. Platelet counts varied widely (range, 19–838 × 109/L) with thrombocytopenia (n = 30) and thrombocytosis (n = 11). Counts correlated directly with leukocytes and reticulocytes; inversely with lactate dehydrogenase, APACHE, and MODS scores. Areas under ROC curve for platelets, MODS, and APACHE scores to predict survival were 0.73, 0.85, and 0.93, respectively.Conclusions:In severe sickle cell crisis thrombocytopenia is more common than thrombocytosis. In the ICU, day 1 platelet counts correlate inversely with prognostic scores and are significantly reduced in multi-organ failure and nonsurvivors. A platelet count above 175 × 109/L predicts patient survival with high specificity and positive predictive value but lacks sensitivity.

Status of Vitamin-D Deficiency in Sickle Cell Disease in Adults

“…Also, sickle cellendothelial interaction results in coagulation factor activation and a state of compensated disseminated intravascular coagulation with platelet consumption. 13 The median Serum creatinine level reported in the study was 0.6200 mg/dl in group A participants and 0.7600 mg/dl amongst group B participants. The range varied from 0.50 to 0.90 mg/dl in control group.…”

“…11 Shanley et al, (2011) also studied the usefulness of platelet count as a predictor of VOC amongst SCD patients and reported larger decline in platelets count in them. 12 Shome DK et al, (2018) suggested the mechanism to explain alteration in platelet count in SCD. They suggested that direct correlations of platelet counts with WBC and reticulocytes found in their study suggest that compromised marrow function is a contributory factor.…”

Sickle Cell Disease Presenting as Extradural Hematoma: An Extremely Rare Fatal Crisis

“…A rare consequence of sickle cell illness is a spontaneous extradural hematoma. The formation of extradural hematomas in SCD has been linked to unestablished pathophysiologies like vaso-occlusion of the hematopoietic calvarial diploic bone resulting in bone infarction and blood leaking into the periosteal, epidural, and sub-galeal regions [2,7]. Acute and rapid increase in hematopoiesis, resulting in microfracture of the already thin inner cortex and blood and hematopoietic tissue extravasation with sludging of sickle cells in the diploic veins, obstructing venous drainage, and causing blood leaking due to vascular injury have also been postulated.…”

Detection of BCL11A and HBS1L-MYB Genotypes in Sickle Cell Anemia

“…With regards to WBC and platelet counts, we found significant increase in the total corrected WBC and platelets which are not unusual in SCA status. The majority of studies performed on SCA patients have shown significant increases in the total counts since the disease is characterised by active inflammation and haemolysis, which trigger continuous production of WBC and platelets resulting in high peripheral counts [18][19][20][21][22][23][24]. A previous study performed on SCA patients to evaluate the laboratory markers during steady states of the disease found that increased emergency department utilisation was significantly associated with elevated steady-state counts of WBC and platelets (p \ 0.001).…”