Thrombocytopenia Is Common In Sepsis And Is Correlated To Mortality
Thrombocytopenia is generally defined as platelet count < 150 G L1 and it is classified as severe if platelet count is < 50 G L1 . It is the most common hemostatic disorder in the intensive care unit with a prevalence of approximately 50% . Interestingly, platelet count is a part of the SOFA score which aims to assess the severity of organ dysfunction in critically ill patients.
Thrombocytopenia is a risk marker, rather than a cause, of mortality in the ICU. Clinicians confronted with this hemostatic disorder or a significant decrease in platelet count should actively identify and try to correct the underlying cause. A detailed history and careful physical examination are keys to achieving the right diagnosis. This should be supported by some laboratory results along with an interpretation of the data within the clinical context.
What Are The Complications Of Thrombocytopenia
People with severe thrombocytopenia are at risk for significant internal and external blood loss, or hemorrhage. Internal bleeding into the digestive tract or brain can be life-threatening.
Having a splenectomy makes you more susceptible to infections. Your spleen is part of your immune system. It helps your body fight off germs. For this reason, patients who have to have their spleen remove are given several vaccinations to help prevent infection.
Mechanisms That Contribute To Thrombocytopenia In Sepsis
Thrombocytopenia is a common and multifactorial phenomenon occurring during sepsis. The main causes are decreased platelet production, hemodilution, platelets consumption, increased sequestration of platelets in microvessels, and immune-mediated destruction of platelets. The combination of a decrease in the production associated to an increase of platelets consumption and destruction coexists.
The first step for the clinician consists of eliminating pseudo-thrombocytopenia due to an artefact of laboratory parameters cause by in vitro platelet agglutination in EDTA-anticoagulated blood. Measuring normal platelet count in citrated blood is usually sufficient to confirm the diagnosis.
Activated platelets have also been shown to promote neutrophil recruitment to the site of injury and the formation of neutrophil extracellular traps which trap and help kill pathogens . Recently, extracellular histones were described as a cause of thrombocytopenia in critically ill patients . Fuchs et al. demonstrated that NETs, which are extracellular DNA fibers comprising histones and neutrophil antimicrobial proteins, were formed inside the vasculature in infectious and noninfectious diseases . They reported that NETs provided a heretofore unrecognized scaffold and stimulus for thrombus formation. NETs perfused with blood cause platelet adhesion, activation and aggregation, whereas NETs formation in animal models caused rapid and profound thrombocytopenia.
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Platelets And Endothelial Cells Interactions During Sepsis
Endothelial cells play a central role in a hosts response to sepsis, including inflammation, coagulation, and vascular permeability. Endothelial cells are not classically considered to be immune cells but they express innate immune receptors such as TLRs, which can be activated by pathogen components or a myriad of host-derived factors, including complement, cytokines, leucocytes, fibrin, and activated platelets and leukocytes .
This complex interaction between circulating platelets, endothelial cells, and subendothelial structures is mediated by cellular receptors on the surface of platelets and endothelial cells, such as integrins and selectins, as described above, and by adhesive proteins, such as fibrinogen and von Willebrand factor . vWF allows initial platelet adhesion to the injured vessel wall by binding the platelet receptor GPIb-IX-V. Large and ultra-large vWF multimers, the most active forms in the promotion of platelet aggregation are cleaved by A Disintegrin and Metalloproteinase with Thrombospondin type 1 motif-13 . The release of significant ultra-large vWF multimers following endothelial damage, associated with a decrease in its cleavage by a consumption of ADAMTS-13, could explain the increase of the platelet-vessel wall interaction during sepsis .
Do You Have A Low Platelet Count Risks & 7 Natural Treatments
Do you tend to bruise easily and have trouble stoping cuts or wounds from bleeding? Or perhaps frequently get nosebleeds or bloody gums? If so, theres a chance you have a low platelet count.
Having a low platelet count a condition called thrombocytopenia is a problem with normal blood clotting and bruising that results from having low levels of thrombocytes, colorless blood cells produced by bone marrow. Thrombocytes are responsible for helping form blood clots in the arteries/veins and stopping bleeding. A low platelet count puts someone at a higher risk for internal bleeding or other blood clotting and blood vessel-related problems and unfortunately can sometimes really take a toll on quality of life.
Idiopathic thrombocytopenia purpura is the type of low platelet count caused by an autoimmune disease that affects how platelets are produced and used in the body. Autoimmune disorders, including arthritis, leukemia and lymphoma, can all trigger ITP, and factors like medication use and toxin exposure can also lower blood platelet counts. Not every patient with low platelet counts has a serious autoimmune disorder. Some cases of mild thrombocytopenia are caused by common lifestyle factors, can be treated pretty easily, and dont even cause any noticeable signs and symptoms at all.
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Platelet Sequestration By The Spleen
Your spleen helps regulate the numbers of red blood cells and platelets in your blood as well as helping to regulate your immune system. The spleen typically stores 30 to 40 percent of your platelets. However, if your spleen becomes enlarged, it can retain up to 90 percent of platelets, leaving only a small number in your blood. Diseases such as blood cancers involving the spleen or liver disease can cause the spleen to become enlarged and sequester a larger number of platelets from circulation in the blood.
- Your spleen helps regulate the numbers of red blood cells and platelets in your blood as well as helping to regulate your immune system.
- Diseases such as blood cancers involving the spleen or liver disease can cause the spleen to become enlarged and sequester a larger number of platelets from circulation in the blood.
How Can I Prevent Thrombocytopenia
If youre at risk for thrombocytopenia, these steps may help prevent it:
- Avoid medicines that thin blood and increase bleeding risk, such as aspirin, naprosyn and ibuprofen.
- Take care with contact sports and activities that can cause injuries, bruising and bleeding.
- Minimize contact with toxic chemicals.
- Take extra care when shaving, brushing your teeth and blowing your nose.
- Limit your intake of alcohol which slows down the production of platelets and causes liver damage.
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How To Increase Platelet Count
There are a number of treatment approaches for an abnormally low platelet count. If the thrombocytopenia is not causing physical symptoms, treatment is usually not required.
However, if a low platelet count is dangerously low or symptomatic, then the cause may need to be treated directly. Since there is a wide range of possible causes, resolving thrombocytopenia often involves treating the underlying medical condition or switching medication.
For certain forms of thrombocytopenia, a doctor might prescribe drugs which suppress the immune system a common medication used for this is the corticosteroid drug prednisolone.
Depending on the cause and if platelet count does not increase, the patient may undergo splenectomy: an operation to remove the spleen. The spleen is essentially a blood filter, but if functioning abnormally, can sometimes become overly destructive to platelets. Response to splenectomy can typically be an increase in platelet count of 30% to 100%.
In emergencies or for chronic and unremitting thrombocytopenia, patients with severely low platelet count or significant bleeding may be treated with blood or platelet transfusions.
What Are Platelets What Are Normal Ranges
Platelets are important elements in the blood that are important for blood coagulation . Thrombocytopenia refers to having a low platelet count in the blood compared to the normal range.
- The normal platelet count ranges between 150,000 and 450,000 per microliter .
- Only about 2/3 of platelets released into the bloodstream circulate in the blood, and the remaining third are typically found in the spleen.
- The life cycle of platelets is usually about 7-10 days therefore, the old ones are continuously being replaced by new ones.
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Can There Be Bleeding Disorders With Normal Numbers Of Platelets
Yes, if platelet function is impaired. This can be a side effect of a number of drugs including some antibiotics. There are inherited platelet defects such as Von Willebrand’s Disease , that are common in certain breeds of dogs, especially Doberman Pinschers. Congenital platelet defects also occur in Otterhounds, Great Pyrenees, American Cocker Spaniels, and Basset Hounds. Diagnosis requires tests of platelet function. There are no specific treatments other than blood transfusions as needed.
| Contributors: Ernest Ward, DVM Updated by Amy Panning, DVM |
What Is High Platelets
High platelets is a condition in which the blood contains more platelets than normal. Platelets are small blood cell fragments that assist in blood clotting. In a healthy person, there are usually 150,000 to 450,000 platelets per microliter of blood. A high platelet count can be identified through routine blood tests.
The occurrence of high platelets is divided into two medical categories: primary thrombocythemia and secondary thrombocytosis. In primary thrombocythemia, the cause of the high platelets is not known, and it occurs as an independent condition. In secondary thrombocytosis, high platelets occurs as a symptom of another disease or condition, such as anemia, infection or .
In many cases, high platelets may not produce specific symptoms. In other cases, the elevation in platelet levels leads to the development of unwanted and unnecessary blood clotting throughout the body, which can produce a number of symptoms.
The presence of high platelets is rarely associated with a medical emergency. However, in some cases, high platelets may cause blood clotting, bleeding or . Seek immediate medical care if high platelets are accompanied by a persistent , difficulty breathing, dizziness, , changes in speech, or or loss of consciousness for even a brief moment.
If your high platelets condition is persistent or causes you concern, seek prompt medical care.
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What Does It Mean When Your Platelet Count Is High
High platelet count can indicate either essential thrombocythemia or reactive thrombocytosis.
Essential thrombocythemia is a rare bone marrow condition which causes the body to overproduce platelets. This is a chronic condition and is caused by genetic mutation, but the reasons for this abnormality are uncertain.
Reactive thrombocytosis is a temporary elevation of the blood cells in response to another condition. While the response itself is often a normal part of acute inflammatory processes, reactive thrombocytosis can be caused by cancer, anemia or certain auto-immune disorders. It generally resolves when the underlying condition is treated.
Platelets are important for the body as they clump or stick together in response to injury and prevent excessive bleeding. However, an abnormally high platelet count means that clotting could happen spontaneously. Blood clots may occur anywhere in the body, but are most common in the hands, feet and brain. Other symptoms of high platelet count include headaches, dizziness, weakness and fainting.
Diagnosis And Management Of Dit
In acutely ill hospitalized patients, the diagnosis of DIT can be challenging. Other potential causes of the thrombocytopenia, including idiopathic thrombocytopenic purpura , DIC, and sepsis, should be considered in the differential diagnosis and appropriate laboratory testing undertaken. Evaluation of the peripheral blood smear may be necessary and can help the hospitalist eliminate spurious platelet clumping as a possibility, and distinguish between bone marrow suppression and peripheral platelet destruction, including microangiopathic etiologies. After initial assessment and review of the peripheral blood, a hematology consultation for evaluation and consideration of bone marrow biopsy, with assessment of marrow aplasia, myelodysplasia, or a neoplastic process, may be prudent, especially in cases of slowly resolving DIT or cases in which diagnosis remains uncertain.
If there are no obvious causes of thrombocytopenia, a careful history of drug exposure, including specific questions about quinine exposure ,23 should be undertaken and possible offending agents discontinued. Importantly, DIT is largely a clinical diagnosis as there are no readily available specific laboratory methods for the diagnosis of DIT, although some specialized centers may have the ability to more easily perform these tests.19
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What Are The Symptoms Of A Low Platelet Count In Children
If the platelet count is not too low, there may not be any visible symptoms. However, if the platelet count is considerably low, children may experience one or more of these symptoms :
- Easy bruising or petechiae
- Gum or nose bleeding that is difficult to stop even after applying pressure
- Continuous bleeding from small wounds
- Blood in urine or vomit
- Black stool
- Fatigue
In some serious cases, bleeding can occur in and around the brain, causing headaches or changes in thoughts and behavior. Internal bleeding requires immediate medical attention .
Key Points About Immune Thrombocytopenic Purpura
- Idiopathic thrombocytopenic purpura is a blood disorder characterized by an abnormal decrease in the number of platelets in the blood.
- A decrease in platelets can result in easy bruising, bleeding gums, and internal bleeding.
- ITP may be acute and resolve in less than 6 months, or chronic and last longer than 6 months.
- Treatment options include a variety of medications that can reduce the destruction of platelets or increase their production.
- In some cases, surgery to remove the spleen is necessary.
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What Diseases Are Caused By Low Platelets
Thrombocytopenia Causes Have a blood disorder that affects your bone marrow, called aplastic anemia. Have cancer such as leukemia or lymphoma, which damages your bone marrow. Have a platelet-lowering disease like Wiskott-Aldrich or May-Hegglin syndromes. Have a virus such as chickenpox, mumps, rubella, HIV, or Epstein-Barr.
How To Treat Thrombocytopenia
The treatment you will receive for thrombocytopenia ultimately depends on the severity and cause of the condition.
If there is no excessive bleeding and platelet counts are not dangerously lowor are still within a safe realmtreatment may consist of little more than monitoring the situation.
Your doctor may schedule some follow-up tests and ask you to pay attention to new bruises or markings. You will be asked to alert them if you notice changes prior to your follow up.
In more severe cases where bleeding is heavier and platelet counts are lower, thrombocytopenia is treated with medicine.
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The Body Breaks Down The Platelets
Even when the bone marrow produces sufficient platelets, thrombocytopenia may occur if the body destroys its healthy platelets. Some factors that cause this condition are
- Autoimmune disorders, such as immune thrombocytopenia, lupus, and rheumatoid arthritis
- A reaction to certain medicines, such as quinine
- Infections, such as mononucleosis and bacterial blood poisoning
How Can Having Low Platelets Affect My Pregnancy And Birth Plan
In February, a very pregnant Mandy Moore, star of the popular TV series âThis Is Us,â revealed that she had to alter her birth plan due to a diagnosis of low blood platelets. Though Moore didnât elaborate on what specifically changed, low platelets is a fairly common condition.
Platelets, also called thrombocytes, are the smallest human blood cells and play a crucial role in blood clotting. Released by your bone marrow, the quantity of these specialized cells in your blood is generally reported on a complete blood count .
Pregnancy is generally a pro-clotting state, which makes sense clotting helps protect women from excessive bleeding at delivery. But there is a delicate balance between activities that help your blood clot and those that cause too much clotting.
At their best, platelets combine with other factors in the blood that control bleeding and help plug holes in the walls of blood vessels.
At their worst, platelets can form clots in the blood vessels in areas that have plaque buildup. This can put you at increased risk for heart attacks and strokes. When you have too few platelets, called thrombocytopenia, maternal complications such as excessive bleeding, premature delivery, or inability to get an epidural can arise.
Thrombocytopenia is often a âsilentâ condition, causing few noticeable symptoms. Patients have reported mild symptoms such as bleeding gums while brushing their teeth, easy bruising, or reddish-purple spots caused by bleeding below the skin.
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Management Of Patients Suspected Of Having Ditp
Treatment of DITP involves discontinuation of the offending drug. In cases of multiple medications, all drugs started within the last 2 weeks should be stopped and replaced if necessary. The platelet count usually starts to recover after 4 to 5 half-lives of the responsible drug or drug metabolite. Of note, platelet transfusion is generally ineffective as long as the drug or its metabolites are present in plasma. High doses of intravenous immunoglobulin can be given to patients with severe thrombocytopenia and bleeding as well as those at high risk of bleeding however, this recommendation is based only on case reports., provides a suggested approach to the management of cases with suspected DITP.
A suggested algorithm to verify the diagnosis of DITP based on clinical assessment supported by complementary laboratory investigations. PLT, platelet. Adapted from Transfus Med Rev., 27, Arnold DM, Nazi I, Warkentin TE, et al. Approach to the diagnosis and management of drug-induced immune thrombocytopenia, 137-145, Copyright , with permission from Elsevier.
The Bone Marrow Is Unable To Make Adequate Platelets
The bone marrow is a spongy tissue inside the bones and contains stem cells, which are responsible for making blood cells. When stem cells are damaged, the production of platelets is affected. Some factors that damage the stem cells are
- Cancers, such as leukemia or lymphoma
- Chemotherapy or radiation therapy
- Aplastic anemia
- Exposure to toxic chemicals such as pesticides
- Medicines, such as chloramphenicol , aspirin, or ibuprofen
- Viral infections, such as mumps, rubella, and chickenpox,
- Genetic disorders, such as Wiskott-Aldrich and May-Hegglin syndromes
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