Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
ISSN
1437-4331
See all formats and pricing
More options …
Volume 52, Issue 10

Issues

Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department

Fabrizio Turvani
  • Department of Medical Sciences, University of Turin, Turin, Italy
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Luca Pigozzi
  • Department of Medical Sciences, University of Turin, Turin, Italy
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Letizia Barutta / Emanuele Pivetta
  • Department of Medical Sciences, University of Turin, Turin, Italy
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Elisa Pizzolato
  • Department of Medical Sciences, University of Turin, Turin, Italy
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Fulvio Morello
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Stefania Battista
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Corrado Moiraghi
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Giuseppe Montrucchio / Enrico Lupia
  • Corresponding author
  • Department of Medical Sciences, University of Turin, Turin, Italy
  • Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-05-09 | DOI: https://doi.org/10.1515/cclm-2014-0224

Abstract

Background: Thrombocytopenia is the most common coagulation disorder in critically ill patients. No studies have investigated the epidemiology and clinical impact of this condition in emergency department (ED) patients. We aimed to investigate epidemiological features, incidence of bleeding, and diagnostic and therapeutic requirements of patients with thrombocytopenia admitted to the ED.

Methods: We performed a retrospective observational study enrolling all patients admitted to the medical-surgical ED of the “Città della Salute e della Scienza di Torino” Hospital with a platelet count <150×109 PLTs/L, during four non-consecutive months. There were no exclusion criteria.

Results: The study included 1218 patients. The percentage of patients with severe (<50×109 PLTs/L) or very severe (<20×109 PLTs/L) thrombocytopenia was about 12%. Thrombocytopenia associated with liver cirrhosis was the most represented etiology. On the contrary, the most frequent cause in patients with newly recognized low platelet count was disseminated intravascular coagulation/sepsis. The incidence of bleeding and hypovolemia, as well as the need of transfusional support and mechanical, surgical or endoscopic hemostasis progressively increased with the severity of thrombocytopenia.

Conclusions: Our results suggest that the detection of a platelet count lower than 50×109 PLTs/L may help to identify patients with higher bleeding risk in the ED setting. Additional studies are required to evaluate whether, in this setting, thrombocytopenia may represent an independent risk factor for bleeding episodes and increased mortality.

Keywords: bleeding risk; emergency department; platelets; thrombocytopenia; transfusions

References

  • 1.

    Chakraverty R, Davidson S, Peggs K, Stross P, Garrard C, Littlewood TJ. The incidence and cause of coagulopathies in an intensive care population. Br J Haematol 1996;93:460–3.Google Scholar

  • 2.

    Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology Am Soc Hematol Educ Program 2010; 2010:135–43.Web of SciencePubMedGoogle Scholar

  • 3.

    Crowther MA, Cook DJ, Meade MO, Griffith LE, Guyatt GH, Arnold DM, et al. Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care 2005;20:348–53.Google Scholar

  • 4.

    Hui P, Cook DJ, Lim W, Fraser GA, Arnold DM. The frequency and clinical significance of thrombocytopenia complicating critical illness: a systematic review. Chest 2011;139:271–8.Web of ScienceGoogle Scholar

  • 5.

    Baughman RP, Lower EE, Flessa HC, Tollerud DJ. Thrombocytopenia in the intensive care unit. Chest 1993;104:1243–7.Google Scholar

  • 6.

    Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med 2000;28:1871–6.Google Scholar

  • 7.

    Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med 2002;30:1765–71.Google Scholar

  • 8.

    Williamson DR, Lesur O, Tétrault J-P, Nault V, Pilon D. Thrombocytopenia in the critically ill: prevalence, incidence, risk factors, and clinical outcomes. Can J Anaesth 2013;60:641–51.Google Scholar

  • 9.

    Howell MD, Powers RD. Utility of thrombocytopenia as a marker for heparin allergy in adult ED patients. Am J Emerg Med 2006;24:268–70.Google Scholar

  • 10.

    Thiolliere F, Serre-Sapin AF, Reignier J, Benedit M, Constantin JM, Lebert C, et al. Epidemiology and outcome of thrombocytopenic patients in the intensive care unit: results of a prospective multicenter study. Intens Care Med 2013;39:1460–8.Google Scholar

  • 11.

    Rebulla P, Finazzi G, Marangoni F, Avvisati G, Gugliotta L, Tognoni G, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell’Adulto. N Engl J Med 1997;337:1870–5.Google Scholar

  • 12.

    Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med 2010;362:600–13.Web of ScienceGoogle Scholar

  • 13.

    Wandt H, Schaefer-Eckart K, Wendelin K, Pilz B, Wilhelm M, Thalheimer M, et al. Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet 2012;380:1309–16.Web of ScienceGoogle Scholar

  • 14.

    Stanworth SJ, Estcourt LJ, Powter G, Kahan BC, Dyer C, Choo L, et al. A no-prophylaxis platelet-transfusion strategy for hematologic cancers. N Engl J Med 2013;368:1771–80.Web of ScienceGoogle Scholar

  • 15.

    Thiele T, Selleng K, Selleng S, Greinacher A, Bakchoul T. Thrombocytopenia in the intensive care unit – diagnostic approach and management. Semin Hematol 2013;50:239–50.Web of ScienceGoogle Scholar

  • 16.

    Pène F, Benoit DD. Thrombocytopenia in the critically ill: considering pathophysiology rather than looking for a magic threshold. Intens Care Med 2013;39:1656–9.Web of ScienceGoogle Scholar

About the article

Corresponding author: Dr. Enrico Lupia, MD, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Torino, Italy, Phone: +39 011 6705395, Fax: +39 011 6705367, E-mail: ; and Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy


Received: 2014-02-28

Accepted: 2014-04-16

Published Online: 2014-05-09

Published in Print: 2014-10-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 52, Issue 10, Pages 1485–1488, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2014-0224.

Export Citation

©2014 by De Gruyter.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Luca Pigozzi, Jonathan Paul Aron, Jonathan Ball, and Maurizio Cecconi
Intensive Care Medicine, 2016, Volume 42, Number 4, Page 583

Comments (0)

Please log in or register to comment.
Log in