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Mechanisms and etiologies of thrombocytopenia in the intensive care unit: impact of extensive investigations

Abstract : AbstractBackground:Thrombocytopenia is common in the intensive care unit. Potential mechanisms and etiologiesbehind this phenomenon are multiple and often entangled. We assessed the effect of a systematic approach, usingroutinely available tests, on the proportion of patients in whom the mechanism (primary objective) and etiology(secondary objective) of thrombocytopenia in a mixed intensive care unit (ICU) could be identified.Methods:Before-and-after study of all patients with thrombocytopenia was used.‘Before’group had no intervention.New standard operating procedures for thrombocytopenia management were introduced. In the‘After’group, bonemarrow aspiration; determination of fibrinogen dosage, prothrombin time, factor V, D-dimers; assay of fibrin monomers,ferritin, triglycerides, lactic acid dehydrogenase, aspartate transaminase, alanine aminotransferase, vitamin B12,folates,reticulocytes, haptoglobin, and bilirubin were performed.Results:In the Before group (n= 20), the mechanism (central, peripheral, or mixed) was identified in 10 % versus 83%in After group (n=23)(p< 0.001) (48% peripheral, 35% mixed). Before intervention,≥1 etiology was identified in 15%versus 95.7% in the After group (p<0.001).Conclusions:Systematic and extensive investigation using routine tests highlights the mechanisms and etiology ofthrombocytopenia in most cases.
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Submitted on : Friday, December 5, 2014 - 1:54:28 PM
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Nadiejda Antier, Jean-Pierre Quenot, Jean-Marc Doise, Robin Noel, Emmanuel Demaistre, et al.. Mechanisms and etiologies of thrombocytopenia in the intensive care unit: impact of extensive investigations. Annals of Intensive Care, SpringerOpen, 2014, 4 (1), pp.24. ⟨10.1186/s13613-014-0024-x⟩. ⟨inserm-01091425⟩

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