Short reviewSepsis-associated thrombocytopenia
Section snippets
Introduction and background
Severe sepsis now accounts for one quarter of all admissions to Intensive Care Units (ICUs) and has an incidence of 60/100,000 in the United Kingdom [1]. Based on recent figures from the United States (US), 19 million cases every year is a conservative estimate of the worldwide incidence of sepsis [2]. This incidence is increasing, resulting in rising costs to healthcare systems. In the US the annual direct cost of sepsis is estimated to have increased from $15.4 billion in 2003 to $24.3
Incidence and implications
The incidence of SAT varies based on the agreed definition, however, broadly speaking a platelet count of below 150,000/μl is accepted as thrombocytopenia. In one study of nosocomial blood stream infections an incidence of thrombocytopenia of 43.2% was observed [16]. In another study of 214 patients with nosocomial sepsis, 70.6% of patients developed a platelet count below 150,000/μl. In a large Canadian study, involving 12 ICUs with 1238 patients with severe sepsis, the overall incidence of
Proposed mechanisms of thrombocytopenia in sepsis
The studies described below illustrate the efforts that have been undertaken to find a pathway that could explain the mechanism of thrombocytopenia in sepsis. Broadly speaking, these studies have examined – decreased platelet production, the role of platelet receptors, immune-mediated thrombocytopenia, platelet sequestration and consumptive coagulopathy.
Other causes of thrombocytopenia in ICU
Examining the various causes of thrombocytopenia in critically ill patients, Vanderschueren et al. reported that the sepsis syndrome was by far the most common cause of a decline in platelet count in the ICU, accounting for over half of the cases in their study [63]. However when diagnosing SAT it is important to consider and outrule the numerous other causes of a low platelet count that can be seen in the critically ill. Table 1 lists some of these other causes that are more likely to be found
Future directions
IL-11 is a platelet growth factor and can be used to prevent chemotherapy-induced thrombocytopenia [66]. Wan et al. recently published a single centre case-control study [67] of the effects of the pleiotropic cytokine recombinant human IL-11 in septic patients with severe thrombocytopenia (platelet count < 50,000/μl) and found that it significantly decreased the mortality rate as compared to a control group. The levels of IL-6 were significantly lower in the treatment group. In addition, there
Conclusion
The development of thrombocytopenia, either a relative or an absolute decrease, during a septic episode is a significant event, associated with a doubling of the expected mortality rate from that episode. The exact mechanism underlying sepsis-associated thrombocytopenia remains unclear and it may be that this is a multifactorial phenomenon. Should a distinct or dominant pathway emerge in this process it is probable that this would be a potential therapeutic target.
Conflicts of interest
None.
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How I use platelet transfusions
2022, BloodCitation Excerpt :Thrombocytopenia is common in critically ill adults, and 5% to 20% will develop severe thrombocytopenia (<50 × 109/L) at some point in their ICU stay.49-51 The underlying etiology is multifactorial,52-56 but thrombocytopenia within the first 24 hours of ICU admission appears to be associated with increased 28-day mortality,57 along with a dysregulated host immune response.58 After patients with cancer, critically ill patients are the second largest group of platelet users.15
Coagulopathy and sepsis: Pathophysiology, clinical manifestations and treatment
2021, Blood ReviewsCitation Excerpt :Common causes of platelet consumption and destruction are the disseminated intravascular coagulopathy (DIC) [42] and thrombotic microangiopathies as the hemolytic–uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) [43]. Furthermore, several drugs can induce platelet destruction and mimic sepsis-induced thrombocytopenia [44–46]. Immune-mediated platelet consumption is not limited to heparin-induced thrombocytopenia (HIT) and is associated with many other medicaments able to cause drug-induced immunologic thrombocytopenia by different mechanisms.
The lipid biology of sepsis
2021, Journal of Lipid ResearchCitation Excerpt :The accumulation of these prothrombotic lipids in CLP sepsis is subsequently accompanied by increased thrombi formation in lung capillaries and enhanced monocyte, neutrophil, and platelet aggregates. Thrombosis and thrombocytopenia are common complications in human patients with sepsis owing to overconsumption of platelets for aggregation or adhesion to the endothelium and leukocytes (23, 24). Other studies also demonstrated similar elevations in eicosanoid lipid mediators during sepsis across species.
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