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Thrombocytopenia in the Intensive Care Unit and After Solid Organ Transplantation

Chapter

Abstract

Thrombocytopenia is common among patients in the intensive care unit (ICU) and the post-solid organ transplantation (SOT) setting. Although such patients may be vulnerable to any of the causes of thrombocytopenia that affect individuals in other settings, certain etiologies are of particular prevalence and clinical relevance. In this chapter, we review the causes and management of, and our diagnostic approach to, thrombocytopenia in ICU and SOT patients. Major etiologies of thrombocytopenia in the ICU include sepsis, drug-induced thrombocytopenia, disseminated intravascular coagulation, dilutional thrombocytopenia, heparin-induced thrombocytopenia, posttransfusion purpura, extracorporeal circuitry, intravascular devices, and surgery. We present an algorithm for determining the likelihood of these respective causes that takes into account the severity of thrombocytopenia, its timing of onset with respect to exposure to drugs and transfusions, the pace of the fall in platelet count, and the presence of thrombosis or hemorrhage. Important diagnostic considerations after SOT comprise drug-induced thrombocytopenia, viral infection, thrombotic microangiopathy, infection-induced hemophagocytic syndrome, post-transplant lymphoproliferative disorder, graft-versus-host disease, and immune thrombocytopenia. The time of onset of thrombocytopenia after SOT and specific laboratory or pathologic testing is helpful in discerning the diagnosis among these causes.

Keywords

Intensive Care Unit Platelet Count Intensive Care Unit Patient Disseminate Intravascular Coagulation Solid Organ Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

CMV

Cytomegalovirus

CPB

Cardiopulmonary bypass

DIC

Disseminated intravascular coagulation

DITP

Drug-induced immune thrombocytopenia

EBV

Epstein–Barr virus

ECMO

Extracorporeal membrane oxygenation

GVHD

Graft-versus-host disease

HHV

Human herpes virus

HIT

Heparin-induced thrombocytopenia

HPA

Human platelet antigen

HPS

Hemophagocytic syndrome

ICU

Intensive care unit

IL

Interleukin

ITP

Immune thrombocytopenia

PCR

Polymerase chain reaction

PTLD

Post-transplant lymphoproliferative disorder

PTP

Posttransfusion purpura

SOT

Solid organ transplantation

TMA

Thrombotic microangiopathy

VAD

Ventricular assist device

VZV

Varicella zoster virus

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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