Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department

Abstract

Background: Thrombocytopenia is the most common coagulation disorder in critically ill patients. No studies have investigated the epidemiology and clinical impact of this condition in emergency department (ED) patients. We aimed to investigate epidemiological features, incidence of bleeding, and diagnostic and therapeutic requirements of patients with thrombocytopenia admitted to the ED. Methods: We performed a retrospective observational study enrolling all patients admitted to the medical-surgical ED of the " Citt à della Salute e della Scienza di Torino " Hospital with a platelet count < 150 × 10 9 PLTs/L, during four non-consecutive months. There were no exclusion criteria. Results: The study included 1218 patients. The percentage of patients with severe ( < 50 × 10 9 PLTs/L) or very severe ( < 20 × 10 9 PLTs/L) thrombocytopenia was about 12%. Thrombocytopenia associated with liver cirrhosis was the most represented etiology. On the contrary, the most frequent cause in patients with newly recognized low platelet count was disseminated intravascular coagulation/sepsis. The incidence of bleeding and hypovolemia, as well as the need of transfusional support and mechanical, surgical or endoscopic hemostasis progressively increased with the severity of thrombocytopenia.

Understanding platelet dysfunction in sepsis

“…Thrombocytopenia, traditionally defined as a platelet count less than 150 9 10 9 /L, is a common haematological alteration in critical illness [3]. In patients with sepsis, thrombocytopenia is associated with a higher vasopressor requirement and a lower PaO 2 /FiO 2 ratio [4].…”

Early platelet level reduction as a prognostic factor in intensive care unit patients with severe aspiration pneumonia

“…Primary thrombocytopenia is usually found in chronic diseases of the blood system, while acquired thrombocytopenia is found in infections, trauma, surgery, drugs, radiotherapy, immune dysfunction, and nutritional disorders. A study of emergency-related thrombocytopenia showed that its main causes included liver cirrhosis, hematological tumors, chemotherapy-induced thrombocytopenia (CIT), disseminated intravascular coagulation (DIC), infection, and drug-mediated thrombocytopenia ( Turvani et al, 2014 ). Infection is one of the causes of thrombocytopenia, in which platelets are mobilized to the blood vessel wall in an inflammatory response, interacting with white blood cells, allowing leukemia to aggregate to the site of inflammation, appearing to plug fissures in the blood vessel wall, and helping to maintain the integrity of blood vessels ( Ho-Tin-Noé et al, 2018 ).…”