Incidence and causes of new onset thrombocytopenia in the medical intensive care unit of a tertiary referral centre in South India

Raja Vasanth, S (2020) Incidence and causes of new onset thrombocytopenia in the medical intensive care unit of a tertiary referral centre in South India. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Thrombocytopenia is one of the most common clinical conditions found in patients admitted in intensive care unit (ICU). It is defined as a drop in platelet count to less than 150,000/μL(1). While some patients are admitted into the ICU with preexisting thrombocytopenia, a sub group of patients develop thrombocytopenia during their course in the intensive care setting – referred to as new onset thrombocytopenia (NOT). NOT has emerged as a significant finding that has shown association with patient outcomes, increased transfusion requirements, length of hospital stay, and acute kidney injury necessitating renal replacement therapy. However, literature is predominantly from the developed world and there is very limited data from India. OBJECTIVES: 1. To study the incidence, causes and the transfusion requirements of new onset thrombocytopenia in the medical intensive care unit. 2. To study the impact of new onset thrombocytopenia on outcomes of critically ill patients in medical intensive care unit (Hospital mortality, Ventilator free days, Requirement of vasopressor support, Acute kidney injury, Need for renal replacement therapy). MATERIALS AND METHODS: This prospective observational cohort study was carried out in the Medical Intensive Care Unit. All consecutive adult patients (age >18 years) who got admitted to MICU/MHDU with a normal platelet count (>150,000/μL) and who gave informed consent were included in the study, except for pregnant women. The platelet count of each enrolled patient was followed up for a period of 14 days or until their discharge from ICU (which ever came earlier).Patients who developed thrombocytopenia, after 48 hours of admission to ICU were further investigated for underlying causes. Subsequently the data for transfusion requirements, ventilator supports, inotrope requirements and hospital mortality were obtained and analyzed. RESULTS: In the eight month study from Oct 2018 to May 2019, 303 patients were enrolled in the study and the incidence of NOT in our study population is 22.8%. Sepsis-associated thrombocytopenia (72.50%) was the major cause for NOT. The difference in hospital mortality between patients with and without NOT (56.5% versus 22.6%) showed statistical significance (p value <0.013) with an associated significant increase in ICU length of stay, transfusion requirements and development of acute kidney injury in patients with NOT (p value < 0.001). CONCLUSION: The incidence of NOT (22.8%) in our study population is comparable with that of the other international studies. Patients with NOT had 2.43 times the risk for mortality and significantly higher requirement of transfusion support and acute renal injury. Thus, it is evident that NOT in a patient during ICU stay has significant prognostic value in defining the outcomes (in terms of mortality) and planning transfusion requirements.

Item Type: Thesis (Masters)
Additional Information: 201731052
Uncontrolled Keywords: New onset thrombocytopenia (NOT), Sepsis-associated thrombocytopenia, ICU transfusion requirement.
Subjects: MEDICAL > Immunohaematology Blood Transfusion
Depositing User: Subramani R
Date Deposited: 05 Feb 2021 16:47
Last Modified: 05 Feb 2021 16:47

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