Severe Thrombocytopenia in Adults with Severe Acute Respiratory Distress Syndrome: Impact of Extracorporeal Membrane Oxygenation Use

Abstract

Extracorporeal membrane oxygenation (ECMO) use is perceived to cause thrombocytopenia (T), but the role of non-ECMO factors in the development of T remains unclear. We sought to evaluate the incidence and factors associated with severe T (platelet count ≤ 50,000/μl) in adults with severe acute respiratory distress syndrome (ARDS) managed with or without ECMO. The ECMO (n = 32) versus the non-ECMO (n = 53) groups had a similar baseline platelet count (214,000 vs. 179,000/μl), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.13), unfractionated heparin (UFH) exposure (p = 0.62), and severe T incidence (25 vs. 19%, p = 0.5). Although the APACHE II score (p = 0.01), presence of liver failure (p = 0.08), and platelet transfusion (p = 0.0009) were different between the severe T (18/85 [21%]) and non-severe T groups (67/85 [79%]), the incidence of septic shock (p = 0.64), heparin infusion use (p = 0.41), exposure to non-heparin T-causing medications (p = 0.77) and ECMO use (p = 0.5) were not. An adjusted multivariate linear regression model revealed that only the APACHE II score was independently associated with the development of severe T (p = 0.01) but use of ECMO was not (p = 0.32) ECMO use may not affect the incidence of severe T among adults with severe ARDS. Larger studies that are prospective in nature are required to confirm this finding.

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

“…2). Severe thrombocytopenia was reported only in 6 studies, and its prevalence ranged from 6.3 to 26.6% [8,24,32,35,37,40]. Five studies reported the timeline of platelet count after ECMO start [7,8,16,24,29].…”

“…The subgroup analysis of thrombocytopenia in V-V ECMO patients included four studies and showed a similar pooled prevalence, 25.4% (95% CI 10.6-61.4; 4 studies), with a high heterogeneity (Fig. 2) [29,32,35,37]. n.a n.a n.a n.a n.a Kalbhenn, 2018 [38] n.a n.a n.a n.a n.a n.a n.a n.a Kimmoun, 2018 [39] n.a Cottini, 2013 [25] n.a n.a Kimmoun, 2018 [39] n.a n.a n.a n.a n.a n.a n.a Ruggeri, 2018 [40] n.a n.a n.a n.a n.a n.a 166/188 (88.3%)…”

miR-146b-3p regulates PI3K/AKT signaling pathway in septic mice with acute respiratory distress syndrome

“…Sepsis-induced ARDS has an estimated incidence of over 40% and is the leading cause of ARDS death [21]. ARDS is a life-threatening complication featured by diffuse alveolar damage [22]. The incidence of ARDS varies widely, ranging from 1.5 patients per 100,000 people to nearly 79 patients per 100,000 people; European countries report lower incidence than the United States; mortality also varies due to the severity, age, and underlying medical conditions [23][24][25][26][27].…”

“…As a complex pathological process, ARDS is regulated by transcription factors as well as miRNA. A miRNA is a small endogenous non-coding RNA molecule that includes approximately [18][19][20][21][22][23][24] nucleotides. It usually complements sites in the 3' untranslated region of the target messenger RNA for inhibiting the expression of post-transcriptional gene [8].…”

Hematologic concerns in extracorporeal membrane oxygenation

“…Thrombocytopenia is common in patients on ECMO. The degree of thrombocytopenia is not related to the duration of ECMO but rather to the severity of illness and platelet count at the time of cannulation 62,63 . The etiology of platelet dysfunction on ECMO is complex and has not yet been definitively elucidated.…”