Thrombocytopenia in surgical ICU patients

Introduction

The aim was to study the incidence, the etiology and to assess the severity of thrombocytopenia in surgical ICU (SICU) patients admitted to the central army hospital of Algiers (Algeria).

Methods

We conducted a retrospective study; all admitted patients during the year 2008 were enrolled in the study (351 patients). All charts were reviewed and different hemograms recorded from admission until discharge. One hundred and fifty-three thrombocytopenia cases defined as a platelet count (plt) <150 × 10⁹ were reported (43.6%).

Results

Among 351 patients (227 survivors, 124 died), 153 developed thrombocytopenia, 96 males and 57 females. The onset of thrombocytopenia was for the majority of patients (98%) at 24 to 72 hours after ICU admission. Only 26% were severe (plt <50 × 10⁹) and 3% <20 × 10⁹). The etiopathology is multifactorial and difficult to obtain precisely: 77% of cases were hemodynamically unstable multitrauma patients (with or without ARDS and fat embolism), and necessitated volume and blood product administration through an intravascular device; sepsis was present in 47% of cases; disseminated intravascular coagulopathy in 33%; and five thrombocytopenia cases were related to drug administration with late onset after the 5th day. Reported mortality was 57% (P < 10^-6) compared with the overall mortality (35.3%), related to the severity of underlying diseases and the associated co-morbidities.

Conclusions

Thrombocytopenia is frequent among chirurgical patients, especially multitrauma patients with cardiovascular instability where aggressive volume and blood product administration is needed.