New Guidelines for Platelet Therapy in ICU

Abstract

P latelets are involved in many processes ranging from fighting microbial infection and triggering inflammation to promoting tumor angiogenesis and metastasis. Nevertheless, the main function of platelets still is stopping hemorrhage following vascular injury. Thrombocytopenia is the most common coagulation problem in the ICU. In critically ill patients, thrombocytopenia is often multifactorial involving four different mechanisms: decrease of platelets production, increase of platelets consumption, dilution or spurious thrombocytopenia. Thrombocytopenia could be considered as a marker of clinical severity rather than a direct cause responsible of higher mortality. Particular attention should be given to platelet count kinetic as it can have a prognostic value in critically ill patients. Platelet transfusion is usually debated in thrombocytopenic critically ill patients. This group of patient is at high risk of bleeding and need frequently invasive interventions. On the other hand, transfusions carry multiple risks (infectious or immune complications). For these reasons, each transfusion decision should take into account several factors: Evaluation of risk of bleeding, depth of thrombocytopenia, cause of thrombocytopenia and comorbidities.