Epidemiology and outcome of thrombocytopenic patients in the intensive care unit: results of a prospective multicenter study.

PURPOSE

To assess the epidemiology of intensive care unit (ICU) patients with thrombocytopenia (TP).

METHODS

All consecutive ICU-admitted patients with TP either on admission or acquired during ICU stay were included. TP was defined as either absolute (platelet count <100 × 10(9)/L) or relative (decrease in the platelet count >30 %). Extensive diagnostic workup of TP including bone marrow aspiration was performed.

RESULTS

Absolute TP was diagnosed in 208 patients and relative TP in 93. In six patients (2 %), no cause of TP was identified. The median number of TP etiologies per patient was two, with sepsis being the leading cause. Bone marrow aspirates were analyzed in 238 patients. They showed a normal megakaryocyte number in 221 (93 %) and provided novel information for diagnosis in 52 (22 %). Results were susceptible to having an impact on patient management in 22 cases (11 %). The frequency of bone marrow aspiration with results susceptible to having an impact on management did not differ between patients with and without disseminated intravascular coagulation (P = 0.22) and with and without sepsis/septic shock (P = 0.7) but was significantly lower in patients with relative TP than in those with absolute TP (P < 0.01). A serious bleeding event was observed in 30 patients (14.9 %) and a nadir platelet count below 50 × 10(9)/L was an independent risk factor (P < 0.05).

CONCLUSIONS

In thrombocytopenic patients, sepsis is the leading cause of TP. Bone marrow aspirates may yield significant information on TP mechanisms and contribute to the subsequent management of patients, especially those with absolute TP.