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The Coagulation Consult pp 115–132Cite as

Thrombocytopenia in the Intensive Care Unit and After Solid Organ Transplantation

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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.

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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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Authors and Affiliations

  1. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Suvasini Lakshmanan M.D. & Adam Cuker M.D., M.S.

  2. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3 Dulles, 3400 Spruce Street, Philadelphia, PA, USA

    Adam Cuker M.D., M.S.

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  1. Suvasini Lakshmanan M.D.
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Correspondence to Adam Cuker M.D., M.S. .

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  1. Hematologic Oncology and Blood Disorders, Cleveland Clinic, Cleveland, Ohio, USA

    Alan Lichtin

  2. Cardiovascular Medicine and Hematology, Cleveland Clinic, Cleveland, Ohio, USA

    John Bartholomew

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Lakshmanan, S., Cuker, A. (2014). Thrombocytopenia in the Intensive Care Unit and After Solid Organ Transplantation. In: Lichtin, A., Bartholomew, J. (eds) The Coagulation Consult. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9560-4_8

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