Thrombocytopenia is extremely common in critical illness. It's generally a consequence rather than a cause of illness, predicting increased mortality. However, we must remain alert for cases where serious hematologic disease is afoot. The major concern here is the ever-looming possibility of heparin-induced thrombocytopenia and thrombosis (HITT). This chapter explores thrombocytopenia and provides an evidence-based framework for approaching HITT.
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The IBCC chapter is located here.
- The podcast & comments are below.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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In your unit, what’s the most common transfusion threshold for platelet transfusion? Let’s say for example, in a patient recovering from stem cell transplantation?
50k for bleeding, 10k for all others. If NSG, whatever fairytale number they make up.
We are lucky enough to have Rotem in some of our units. If available, and in the right context, I’d follow the extem for these patients.
Great post, as always.
About HIT, I would like to share this study that I’ve found it looks really clever and underestimated.
If you have in your unit the whole blood impedance aggregometry (Multiplate) you can detect an enhaced platlet aggregation (like it occours during HIT) adding heparin to your blood sample. It is really fast and it don’t take days as for anti-PF4.
Here is the link
DOI: 10.1016/j.thromres.2009.12.001
Best regards
Carlo