RT Book, Section
A1 Chapin, John C.
A1 Desancho, Maria T.
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136414845
T1 Hematologic Dysfunction in the ICU
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136414845
RD 2024/04/16
AB KEY  POINTSThe  most  common  reasons  for  hematologic  consultation  in  critically  ill  patients  include  thrombocytopenia,  anemia,  and  less  commonly,  evaluation  of  leukocytosis  and  thrombocytosis.Coagulopathies  including  severe  bleeding  and  thrombotic  disorders  are  very  prevalent  in  intensive  care  unit  (ICU)  patients  due  to  their  underlying  conditions  including  liver  dysfunction  and  acquired  vitamin  K  deficiency.  Bleeding  can  occur  due  to  renal  insufficiency  and  the  use  of  antiplatelet  agents  and  anticoagulant  therapy.Inflammation  occurs  in  sepsis,  systemic  inflammatory  response  syndrome,  and  other  critical  illnesses,  and  causes  alterations  in  both  hemostasis  and  fibrinolysis.Disseminated  intravascular  coagulation  (DIC)  is  observed  in  approximately  50%  of  patients  with  sepsis,  and  is  an  independent  predictor  of  morbidity  and  mortality.Thrombocytopenia  (platelet  count  <  150,000/L)  occurs  in  15%  to  58%  of  ICU  patients  and  may  be  due  to  medications,  infections,  DIC,  thrombotic  microangiopathies  (thrombotic  thrombocytopenic  purpura  [TTP]  and  atypical  hemolytic  uremic  syndrome),  heparin-induced  thrombocytopenia  (HIT),  catastrophic  antiphospholipid  syndrome,  and  immune  thrombocytopenic  purpura.HIT  is  a  clinicopathologic  diagnosis  that  occurs  in  1%  to  4%  of  patients  on  unfractionated  heparin  (UFH),  and  less  than  1%  of  patients  on  low-molecular-weight  heparin  (LMWH).  It  is  more  common  in  postsurgical  patients  than  medical  inpatients  and  in  females.Prompt  interaction  between  the  intensivist  and  the  hematologist  is  key  to  optimize  the  care  of  critically  ill  patients  with  hematologic  dysfunction.