cogitation objective: To determine the prevalence of thrombocytopenia in an ICU and assess which factors were associated with thrombocytopenia.

Design: A review of the medical records of patients admitted during 3 separate month during 1 academic year. Patients must have survived at least 12 h in the ICU.

Setting: A medical ICU at a university hospital.

Patients: General medicine patients admitted to the ICU.

Interventions: All medical records were reviewed. During the ICU stay, daily medications, conclusions and platelet count were noted. All patients were followed up until death or hospital discharge. In 22 patients, including 18 who had thrombocytopenia, bone marrow aspirates were performed.

Measurements and results: undivided hundred sixty-two admisions were evaluated. Thirty-eight (23 percent) had platelet numbers less than 100,000/[mm.sup.3] at least formerly and 17 (10 percent) patients had platelet numbers less than 50,000/[mm.sup.3]]. Several factors were associated with thrombocytopenia; however, simply sepsis, use of antineoplastic chemotherapy, elevated creatinine plain or elevated bilirubin value were independent risk factors for rigorous thrombocytopenia. In only individual patient were the bone marrow findings different from those awaited by the clinical presentation. Thrombocytopenia was associated with longer hospital stay (p[les than]0.001) and higher mortality (p[les than]0.001).

Conclusion: Thrombocytopenia is a usual occurrence in the ICU, usually suitable to the underlying disease, and is associated with an increased mortality.

Thrombocytopenia can be a life-threatening condition collisioned in the ICU. Thrombocytopenia has been associated with spontaneous bleeding into vital organs, including the gastrointestinal tract, brain, heart, and adrenal glands, resulting in significant morbidity and mortality.[1]

In the ICU, there are several conditions which are associated with thrombocytopenia, including sepsis,[2-4] adult respiratory distress syndrome (ARDS),[5,6] and malignancy. In addition, invasive catheters, especially pulmonary artery catheters, have been shown to lower the platelet count[78] Many of the remedys commonly used in the ICU may have an issue on the platelet count. These unsalable articles include heparin[9,10] and penicillin and penicillin analogues.[11,12]

To determine the prevalence, cause, and significance of thrombocytopenia in the ICU, we studied all patients admitted to a medical ICU during three 1-month intervals. Bone marrow examination was occupyed in many of these patients in order to determine the etiology of unexplained thrombocytopenia. We raise that thrombocytopenia was common in the ICU, that it was associated with several definable independent risk factors, that routine bone marrow examination was of little value in assessing these patients, and that the finding of thrombocytopenia was associated with increased mortality.

METHODS

Clinical Data

Patients admitted to the Medical ICU of the University of Cincinnati Medical Center during the month of January, March, or July of single academic year comprised the reflection population. During those months, all patients were beneath the care of the same attending physician (RPB) Patients were studied if they survived at least 12h in the ICU and if there was sufficient information (eg a standard physical examination) regarding the patient. Of the total of 203 admissions, 162 (80 percent) patients survived at least 12 h and thus were not evaluated.

Patient's charts were retrospectively reviewed and a daily platelet judge drug history, presence of monitoring equipment, lowest flush of oxygenation, blood pressure, and transfusion record were recorded for each ICU day. Patients were followed up until discharge from the hospital or death. The final consequence of each patient was noted.

The serum creatinine flush was available in 158 (97 percent) of the patients, the protime in 130 (80 percent) of the patients, and serum bilirubin value in 103 (63 percent) of the patients. Splenomegaly was evaluated according to physical examination only. Patients were considered septic if the same or more blood cultures were positive for bacteria. No patient had documented fungemia during the time of the application of mind Shock was defined as a systolic family pressure of less than 90 mm Hg Patients were considered to have central lines if the femoral, internal jugular, or subclavian veins were cannulated. Patients could be expos to heparin in three possible ways: abounding anticoagulation with heparin, treatment with 5000 units subcutaneously each 12 h ("mini-dose heparin"), or the small amounts used to flush indwelling vascular catheters. The association of heparin usage and thrombocytopenia was calculated for patients with any heparin frontage as well as for patients receiving abounding dosages of heparin. Patients were considered hypoxemic if the [POsub2] was les than 60 mm Hg while breathing extent air, or if supplemental oxygen was urgencyed to maintain a [PaO.sub.2] of more than 80 mm Hg Patients were believed to have ARDS if they had diffuse pulmonary infilitrates, no evidence of left ventricular failure, and required positive end-expiratory influence PEEP to maintain a [Posub2] of more than 80 mm Hg During the time of the studious mood PEEP was not used in the absence of ARDS. Therefore, we could not evaluate the drift of PEEP independent of ARDS.

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