Newly developed thrombocytopenia in medical intensive care patients

Full text

Introduction

Thrombocytopenia is a major concern in intensive care medicine. The incidence is greatly varying depending on the clinical setting.

Objective

To determine the incidence, severity, prognosis and therapeutic implications of thrombocytopenia in our 12-bed medical (noncoronary) ICU.

Methods

We evaluated, in a prospective observational study over 13 months (1.11.1997-30.11.1998), all patients who stayed longer than 48 h in the ICU. Thrombocytopenia was defined as a platelet count below 150000/μl.

Results

We studied 243 patients (63.3% male) with a mean age of 57.9 (± 16.34, 18-96) years, a mean APACHE II score of 21.2 (± 10.06, 0-49) and a mean length of stay of 13.5 days. Thrombocytopenia was observed frequently: only 82 patients (33.7%) were never thrombocytopenic. Ninety-nine (40.7%) patients were thrombocytopenic on admission. From the 144 patients who had normal platelets on admission 62 (45.2%) developed thrombocytopenia. In this group of patients, ICU mortality was significantly correlated with the degree of thrombocytopenia: 66.7% in patients with platelets <20000/μl, 55.6% in patients with platelets 20000-50000, 47.4% in patients with platelets 50000-100000, 9.7% in patients with platelets 100000-150000 (P=0.003 χ²).

Conclusion

45.2% of patients became thrombocytopenic during their ICU stay. The degree of newly developed thrombocytopenia was highly correlated with mortality, length of stay, initial APACHE II score and the consumption of blood products.

Table