Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department

Fabrizio Turvani; Luca Pigozzi; Letizia Barutta; Emanuele Pivetta; Elisa Pizzolato; Fulvio Morello; Stefania Battista; Corrado Moiraghi; Giuseppe Montrucchio; Enrico Lupia

doi:10.1515/cclm-2014-0224

Article

Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department

Fabrizio Turvani , Luca Pigozzi , Letizia Barutta , Emanuele Pivetta , Elisa Pizzolato , Fulvio Morello , Stefania Battista , Corrado Moiraghi , Giuseppe Montrucchio and Enrico Lupia

Published/Copyright: May 9, 2014

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 52 Issue 10

Abstract

Background: Thrombocytopenia is the most common coagulation disorder in critically ill patients. No studies have investigated the epidemiology and clinical impact of this condition in emergency department (ED) patients. We aimed to investigate epidemiological features, incidence of bleeding, and diagnostic and therapeutic requirements of patients with thrombocytopenia admitted to the ED.

Methods: We performed a retrospective observational study enrolling all patients admitted to the medical-surgical ED of the “Città della Salute e della Scienza di Torino” Hospital with a platelet count <150×10⁹ PLTs/L, during four non-consecutive months. There were no exclusion criteria.

Results: The study included 1218 patients. The percentage of patients with severe (<50×10⁹ PLTs/L) or very severe (<20×10⁹ PLTs/L) thrombocytopenia was about 12%. Thrombocytopenia associated with liver cirrhosis was the most represented etiology. On the contrary, the most frequent cause in patients with newly recognized low platelet count was disseminated intravascular coagulation/sepsis. The incidence of bleeding and hypovolemia, as well as the need of transfusional support and mechanical, surgical or endoscopic hemostasis progressively increased with the severity of thrombocytopenia.

Conclusions: Our results suggest that the detection of a platelet count lower than 50×10⁹ PLTs/L may help to identify patients with higher bleeding risk in the ED setting. Additional studies are required to evaluate whether, in this setting, thrombocytopenia may represent an independent risk factor for bleeding episodes and increased mortality.

Keywords: bleeding risk; emergency department; platelets; thrombocytopenia; transfusions

Corresponding author: Dr. Enrico Lupia, MD, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Torino, Italy, Phone: +39 011 6705395, Fax: +39 011 6705367, E-mail: enrico.lupia@unito.it; and Emergency Medicine Unit, “Città della Salute e della Scienza di Torino” Hospital, Turin, Italy

Acknowledgments

This work was supported by Ministero dell’Università e della Ricerca Scientifica e Tecnologica (MURST) ex-60%, and Progetto di Ricerca Sanitaria Finalizzata – Regione Piemonte to GM and EL.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article. Research support played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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Received: 2014-2-28

Accepted: 2014-4-16

Published Online: 2014-5-9

Published in Print: 2014-10-1

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Articles in the same Issue

https://doi.org/10.1515/cclm-2014-0224

Keywords for this article

bleeding risk; emergency department; platelets; thrombocytopenia; transfusions