Mechanisms and etiologies of thrombocytopenia in the intensive care unit: impact of extensive investigations

Background: Thrombocytopenia is common in the intensive care unit. Potential mechanisms and etiologies behind this phenomenon are multiple and often entangled. We assessed the effect of a systematic approach, using routinely available tests, on the proportion of patients in whom the mechanism (primary objective) and etiology (secondary objective) of thrombocytopenia in a mixed intensive care unit (ICU) could be identified. Methods: Before-and-after study of all patients with thrombocytopenia was used. `Before' group had no intervention. New standard operating procedures for thrombocytopenia management were introduced. In the `After' group, bone marrow aspiration; determination of fibrinogen dosage, prothrombin time, factor V, D-dimers; assay of fibrin monomers, ferritin, triglycerides, lactic acid dehydrogenase, aspartate transaminase, alanine aminotransferase, vitamin B-12, folates, reticulocytes, haptoglobin, and bilirubin were performed. Results: In the Before group (n = 20), the mechanism (central, peripheral, or mixed) was identified in 10 % versus 83% in After group (n = 23) (p < 0.001) (48% peripheral, 35% mixed). Before intervention, >= 1 etiology was identified in 15% versus 95.7% in the After group (p < 0.001). Conclusions: Systematic and extensive investigation using routine tests highlights the mechanisms and etiology of thrombocytopenia in most cases.