Ebook Hematologic problems in the critically ill: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Hematologic problems in the critically ill: Part 2
Ebook Hematologic problems in the critically ill: Part 2
Chapter 6The Critically Ill Patientwith Abnormal Platelet CountLuca G. Mascarelli and Paola PradellaAbnormal platelet counts are a common finding in c Ebook Hematologic problems in the critically ill: Part 2critically ill patients. Whereas thrombocytopenia, defined as a platelet count less than 150* 1 ()9/L, affects 13-60 % of Intensive Care Unit (ICƯ) patients [1] and has been extensively studied, the occurrence of thrombocytosis (platelet counts >400*109/L) is observed less frequently and has not bee Ebook Hematologic problems in the critically ill: Part 2n studied to the same extent.In this chapter, the main causes of thrombocytopenia and thrombocytosis in critically ill patients will be illustrated, aEbook Hematologic problems in the critically ill: Part 2
nd their implications on morbidity and mortality will be discussed. Due to its importance in the ICƯ setting, a section in this chapter will be dedicaChapter 6The Critically Ill Patientwith Abnormal Platelet CountLuca G. Mascarelli and Paola PradellaAbnormal platelet counts are a common finding in c Ebook Hematologic problems in the critically ill: Part 2. Trieste 34149. Italye-mail: luca.mascaretti@aots.sanita.fvg.itp. Pradclla. MScHemostasis and Blood Coagulation Laboratory.Transfusion Medicine Department, University Hospital Trieste.Slrada di Fiume 447, Trieste 34149. Italye-mail: paola.pradella@aots.sanita.fvg.itG. Berlol. G. Pozzato (eds.). Hem Ebook Hematologic problems in the critically ill: Part 2atologic Problems in the Critically III, 59 DOI 10.1007/978-88470-53014_6. © Springer-Vcrlag Italia 201560L.G. Mascarelli and p. Pradella6.1 ThrombocyEbook Hematologic problems in the critically ill: Part 2
topenia: A ClassificationBefore addressing the issues related to “true” thrombocytopenia. pseudo (or spurious) thrombocytopenia must be defined. In soChapter 6The Critically Ill Patientwith Abnormal Platelet CountLuca G. Mascarelli and Paola PradellaAbnormal platelet counts are a common finding in c Ebook Hematologic problems in the critically ill: Part 2sponsible for platelet clumping, which, not being delected by cell counters, will lead to falsely low platelet counts [2]. Pseudothrombocytopenia is not clinically significant and is diagnosed by microscopic examination of the blood smear (Fig. 6.1) and by repeating the whole blood count in tubes wi Ebook Hematologic problems in the critically ill: Part 2th a different anticoagulant (heparin- or citrate-based solutions).“True” thrombocytopenia, to a variable degree, affects all types of ICU patients inEbook Hematologic problems in the critically ill: Part 2
all parts of the world; adult medical ICU patients arc mostly affected, but it is also observed in surgical and pediatric patients. These observationChapter 6The Critically Ill Patientwith Abnormal Platelet CountLuca G. Mascarelli and Paola PradellaAbnormal platelet counts are a common finding in c Ebook Hematologic problems in the critically ill: Part 2 threshold value of 150*109/L is generally accepted to indicate thrombocytopenia, stable platelet counts between 150 and 100* 1 ()9/L are not necessarily considered pathological. Moreover, it is now recognized that the risk of clinically spontaneous bleeding is significantly high when platelet count Ebook Hematologic problems in the critically ill: Part 2s fall below 20-10*10M/L [3].rhe two main mechanisms responsible for thrombocytopenia arc reduced production and increased destruction of platelets; lEbook Hematologic problems in the critically ill: Part 2
ess frequently, a reduced platelet count may also be due to sequestration and hemodilution 11.2|.Table 6.1 summarizes the main classification criteriaChapter 6The Critically Ill Patientwith Abnormal Platelet CountLuca G. Mascarelli and Paola PradellaAbnormal platelet counts are a common finding in c Ebook Hematologic problems in the critically ill: Part 2ytopenia in pregnancy and postpartum, since these conditions go beyond the scope of this chapter.6 The Critically Ill Patient with Abnormal Platelet Count61Fig. 6.1 Diagnostic algorithm based on blood smear (Adapted from Stasi [3])Il should always be remembered that in a significant number of cases, Ebook Hematologic problems in the critically ill: Part 2 thrombocytopenia is due to multiple factors, such as for example ill sepsis.The diagnostic workup for thrombocytopenia must include, in addition to lEbook Hematologic problems in the critically ill: Part 2
aboratory tests discussed in this chapter, a familyTable 6.1 Causes of thrombocytopenia Main classification criteriaPathological mechanismExampleit) sChapter 6The Critically Ill Patientwith Abnormal Platelet CountLuca G. Mascarelli and Paola PradellaAbnormal platelet counts are a common finding in c Ebook Hematologic problems in the critically ill: Part 2ocytic thrombocytopenia Secondary bone-marrow failureSepsis, severe idiopathic aplastic anemia, severe |8] malnutrition Infiltration of bone marrow due toAcute leukemia, widespread marrow metastases |9] neoplastic diseases Infiltration of bone marrow due toGaucher's disease110] storage disorders Dru Ebook Hematologic problems in the critically ill: Part 2g-related marrow suppressionChemotherapy, other drugs11 11 Marrow failure due to radiation therapy Internal radiation, external radiation112|rEnhancedEbook Hematologic problems in the critically ill: Part 2
Nonimmune: mechanicalIntravascular devices such as central venous[13] destructioncatheters, intraaortic balloon pump Nonimmune: microangiopathicThrombChapter 6The Critically Ill Patientwith Abnormal Platelet CountLuca G. Mascarelli and Paola PradellaAbnormal platelet counts are a common finding in c Ebook Hematologic problems in the critically ill: Part 2,,,,"S Nonimmune: platelet aggregationDrugs1111-0 Immune: platelet specificImmune thrombocytopenicpurpura (ITP)[16]Q. auto-antibodies=Q Immune: immune complexesAutoimmune disorders|17] < (0 3 b o2Immune: cell-mediated1iypersplenism, hemophagocy tic lyinphohistiocytosis[18]O' a* cImmune:Posttransfusi Ebook Hematologic problems in the critically ill: Part 2on purpura[191nplatelet-specific al lo-anti bodiesoImmune: DrugsDrug related immune thrombocytopenia:(III•-Gọi ngay
Chat zalo
Facebook