Elsevier

Thrombosis Research

Volume 141, May 2016, Pages 11-16
Thrombosis Research

Short review
Sepsis-associated thrombocytopenia

https://doi.org/10.1016/j.thromres.2016.02.022Get rights and content

Highlights

  • Incidence and significance of sepsis-associated thrombocytopenia (SAT).

  • Analysis of studies examining potential mechanisms of SAT.

  • Discussion of other causes of thrombocytopenia in ICU.

  • Summary of ongoing research in this area.

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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