Journal of Thrombosis and Thrombolysis

, Volume 43, Issue 4, pp 429–436 | Cite as

Etiology and complications of thrombocytopenia in hospitalized medical patients

Article

Abstract

To determine incidence, risk factors, hematologic complications, and prognostic significance of thrombocytopenia in the general medicine population, we performed a single-institutional, retrospective study of all adult patients admitted to a general medical ward from January 1st, 2014 to December 31st, 2014 with hospital-acquired thrombocytopenia. Those with moderate thrombocytopenia, defined as a platelet count nadir of <100 × 10^9/L and/or a >50% relative decline, were compared to those with less severe thrombocytopenia. Of the 7420 patients admitted, 465 (6.3%) developed hospital-acquired thrombocytopenia. Infection and moderate thrombocytopenia were present in 56 and 23%, respectively. Severe sepsis and antibiotic use were both associated with moderate thrombocytopenia, and proton pump inhibitor use was statistically significant in both univariate and multivariate analysis. Hematologic complications were more frequent with moderate thrombocytopenia, including frequency of HIT testing and red blood cell transfusions. Outcome metrics including transfer to an intensive care unit (OR 6.78), death during admission (OR 6.85), and length of stay (10.6 vs. 5.1 days) were all associated with moderate thrombocytopenia. Thrombocytopenia is associated with poor prognosis, and the association between moderate thrombocytopenia and proton pump inhibitor use is relatively novel and should be validated in prospective studies.

Keywords

Thrombocytopenia Infections Heparin-induced thrombocytopenia Hospital-acquired Critical illness 

Supplementary material

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References

  1. 1.
    Murphy MF, Metcalfe P, Waters AH, Carne CA, Weller IVD, Linch DC et al (1987) Incidence and mechanism of neutropenia and thrombocytopenia in patients with human immunodeficiency virus infection. Br J Haematol 66(3):337–340CrossRefPubMedGoogle Scholar
  2. 2.
    Cohen P, Gardner FH. Thrombocytopenia as a laboratory sign and complication of gram-negative bacteremic infection. Arch Intern Med. 1966;117(1):113–124.CrossRefGoogle Scholar
  3. 3.
    Laber DA, Martin ME (2005) Etiology of thrombocytopenia in all patients treated with heparin products. Eur J Haematol 75(2):101–105CrossRefPubMedGoogle Scholar
  4. 4.
    Oliveira GB, Crespo EM, Becker RC, Honeycutt EF, Abrams CS, Anstrom KJ et al (2008) Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy. Arch Intern Med 168(1):94–102CrossRefPubMedGoogle Scholar
  5. 5.
    Nikolsky E, Sadeghi HM, Effron MB, Mehran R, Lansky AJ, Na Y et al (2005) Impact of in-hospital acquired thrombocytopenia in patients undergoing primary angioplasty for acute myocardial infarction. Am J Cardiol 96(4):474–481CrossRefPubMedGoogle Scholar
  6. 6.
    Teo CP, Kueh YK (1989) Incidence of thrombocytopenia in an acute care hospital. Ann Acad Med Singapore 18(4):379–381PubMedGoogle Scholar
  7. 7.
    Vaughan JL, Fourie J, Naidoo S, Subramony N, Wiggill T, Alli N (2015) Prevalence and causes of thrombocytopenia in an academic state-sector laboratory in Soweto, Johannesburg, South Africa. S Afr Med J 105(3):215–219CrossRefPubMedGoogle Scholar
  8. 8.
    Horvath MM, Winfield S, Evans S, Slopek S, Shang H, Ferranti J (2011) The deduce guided query tool: providing simplified access to clinical data for research and quality improvement. J Biomed Inform 44(2):266–276CrossRefPubMedGoogle Scholar
  9. 9.
    Hui P, Cook DJ, Lim W, Fraser GA, Arnold DM (2011) The frequency and clinical significance of thrombocytopenia complicating critical illness: a systematic review. Chest 139(2):271–278CrossRefPubMedGoogle Scholar
  10. 10.
    Crowther MA, Cook DJ, Meade MO, Griffith LE, Guyatt GH, Arnold DM et al (2005) Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care 20(4):348–353CrossRefPubMedGoogle Scholar
  11. 11.
    Crespo EM, Oliveira GB, Honeycutt EF, Becker RC, Berger PB, Moliterno DJ et al (2009) Evaluation and management of thrombocytopenia and suspected heparin-induced thrombocytopenia in hospitalized patients: the complications after thrombocytopenia caused by heparin (CATCH) registry. Am Heart J 157(4):651–657CrossRefPubMedGoogle Scholar
  12. 12.
    Venkata C, Kashyap R, Farmer JC, Afessa B (2013) Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J Intensive Care 1(1):9CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lim SY, Jeon EJ, Kim HJ, Jeon K, Um SW, Koh WJ et al (2012) The incidence, causes, and prognostic significance of new-onset thrombocytopenia in intensive care units: a prospective cohort study in a Korean hospital. J Korean Med Sci 27(11):1418–1423CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cox D, Kerrigan SW, Watson SP (2011) Platelets and the innate immune system: mechanisms of bacterial-induced platelet activation. J Thromb Haemost 9(6):1097–1107CrossRefPubMedGoogle Scholar
  15. 15.
    Hawiger J, Hawiger A, Steckley S, Timmons S, Cheng C (1977) Membrane changes in human platelets induced by lipopolysaccharide endotoxin. Br J Haematol 35(2):285–299CrossRefPubMedGoogle Scholar
  16. 16.
    Poskitt TR, Poskitt PK (1985) Thrombocytopenia of sepsis. The role of circulating IgG-containing immune complexes. Arch Intern Med 145(5):891–894CrossRefPubMedGoogle Scholar
  17. 17.
    François B, Trimoreau F, Vignon P, Fixe P, Praloran V, Gastinne H (1997) Thrombocytopenia in the sepsis syndrome: role of hemophagocytosis and macrophage colony-stimulating factor. Am J Med 103(2):114–120CrossRefPubMedGoogle Scholar
  18. 18.
    Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D et al (2000) Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. N Engl J Med 342(25):1855–1865CrossRefPubMedGoogle Scholar
  19. 19.
    Koduri PR, Nathan S (2006) Acute splenic sequestration crisis in adults with hemoglobin S-C disease: a report of nine cases. Ann Hematol 85(4):239–243CrossRefPubMedGoogle Scholar
  20. 20.
    Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R et al (2015) Posttransfusion purpura occurrence and potential risk factors among the inpatient US elderly, as recorded in large Medicare databases during 2011 through 2012. Transfusion 55(2):284–295CrossRefPubMedGoogle Scholar
  21. 21.
    Aster RH, Bougie DW (2007) Drug-induced immune thrombocytopenia. N Engl J Med 357(6):580–587CrossRefPubMedGoogle Scholar
  22. 22.
    Smythe MA, Koerber JM, Mattson JC (2007) The incidence of recognized heparin-induced thrombocytopenia in a large, tertiary care teaching hospital. Chest 131(6):1644–1649CrossRefPubMedGoogle Scholar
  23. 23.
    Prandoni P, Siragusa S, Girolami B, Fabris F, Group BI (2005) The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study. Blood 106(9):3049–3054CrossRefPubMedGoogle Scholar
  24. 24.
    Lindhoff-Last E, Nakov R, Misselwitz F, Breddin HK, Bauersachs R (2002) Incidence and clinical relevance of heparin-induced antibodies in patients with deep vein thrombosis treated with unfractionated or low-molecular-weight heparin. Br J Haematol 118(4):1137–1142CrossRefPubMedGoogle Scholar
  25. 25.
    Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A (2006) Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 4(4):759–765CrossRefPubMedGoogle Scholar
  26. 26.
    Dotan E, Katz R, Bratcher J, Wasserman C, Liebman M, Panagopoulos G et al (2007) The prevalence of pantoprozole associated thrombocytopenia in a community hospital. Expert Opin Pharmacother 8(13):2025–2028CrossRefPubMedGoogle Scholar
  27. 27.
    Kallam A, Singla A, Silberstein P (2015) Proton pump induced thrombocytopenia: A case report and review of literature. Platelets 26(6):598–601CrossRefPubMedGoogle Scholar
  28. 28.
    Ranzino AM, Sorrells KR, Manor SM (2010) Possible acute thrombocytopenia post esomeprazole and hydantoin coadministration. J Pharm Pract 23(2):140–143CrossRefPubMedGoogle Scholar
  29. 29.
    Watson TD, Stark JE, Vesta KS (2006). Pantoprazole-induced thrombocytopenia. Ann Pharmacother 40(4):758–761CrossRefPubMedGoogle Scholar
  30. 30.
    Binnetoglu E, Akbal E, Sen H, Gunes F, Erbag G, Asik M et al (2015) Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding. Platelets 26(1):10–12CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of MedicineDuke University Medical CenterDurhamUSA
  2. 2.Division of HematologyDuke University Medical CenterDurhamUSA
  3. 3.Division of HematologyDUMCDurhamUSA

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