62 Disseminated Intravascular Coagulation and Thrombocytopenia	497

–Single-donor platelets (SDP)

–HLA-matched platelets

•Platelet transfusions are contraindicated in thrombotic thrombocytopenic purpura (TTP), idiopathic thrombocytopenic purpura (ITP), and HIT unless the patient is bleeding.

Step 5: Assess rise in platelet count after platelet transfusion

•Platelet counts should be measured 10–60 min after transfusion. Posttransfusion counts at 10–60 min are sensitive to immune platelet destruction. Posttransfusion counts at 24 h assess platelet survival, which is sensitive to nonimmune factors.

•The patient is considered refractory to platelet transfusions if two or three consecutive transfusions are ineffective.

•Alloimmunization is confirmed by demonstrating antibodies to specific human leukocyte antigen (HLA) or human platelet antigen (HPA).

Step 6: Understand strategies to improve response to platelet transfusions (Table 62.7)

•Treat underlying condition.

•Transfuse ABO identical platelets.

•Transfuse platelets less than 48 h in storage.

•Increase number of platelets transfused.

•Select compatible donor: HLA-matched, ABO compatible.

Step 7: Treat underlying cause

•Review and stop all offending medication.

•Evaluate the patient for evidence of secondary infection or DIC.

Suggested Reading

1.Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol. 2009;145:24–33.

These are evidence-based guidelines diagnosis and management of DIC.

2.Gando S, Saitoh D, Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: results of a multicenter, prospective survey. Crit Care Med. 2008;36(1):145–50.

3.Levi M. Current understanding of disseminated intravascular coagulation. Br J Haematol. 2008;124:567–76.

A very good review on pathogenesis of DIC.

4.Yu M, Nardella A, Pechet L. Screening tests of disseminated intravascular coagulation: guidelines for rapid and specific laboratory diagnosis. Crit Care Med. 2000;28:1777–80.

5.Rice TW, Wheeler AP. Coagulopathy in critically ill patients: part 1: platelet disorders. Chest. 2009;136(6):1622–30.

This article reviews the most frequent causes of thrombocytopenia by providing an overview of the following most common mechanisms: impaired production, sequestration, dilution, and destruction. Guidelines for treating thrombocytopenia and platelet dysfunction are also provided.

498	V. Patil et al.

6.Stroncek DF, Rebulla P. Platelet transfusions. Lancet. 2007;370(9585):427–38.

It reviews commonly used platelet components, product modifications, transfusion practices, and adverse consequences of platelet transfusions.

7.Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med. 2007;357(6):580–7.

A comprehensive review article.

8.Napolitano LM, Warkentin TE. Heparin-induced thrombocytopenia in the critical care setting: diagnosis and management. Crit Care Med. 2006;34(12):2898–911.

This review article summarizes the pathogenesis and clinical consequences of HIT, describes the diagnostic process, and reviews currently available treatment options.

Website

1. http://www.bcshguidelines