title: Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department.
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 <150×10(9) PLTs/L, during four non-consecutive months. There were no exclusion criteria.
  
  
  RESULTS
  The study included 1218 patients. The percentage of patients with severe (<50×10(9) PLTs/L) or very severe (<20×10(9) 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 50×10(9) 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.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Turvani
authors.forename: Luca
authors.initials: L
authors.lastname: Pigozzi
authors.forename: Letizia
authors.initials: L
authors.lastname: Barutta
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pivetta
authors.forename: Elisa
authors.initials: E
authors.lastname: Pizzolato
authors.forename: Fulvio
authors.initials: F
authors.lastname: Morello
authors.forename: Stefania
authors.initials: S
authors.lastname: Battista
authors.forename: Corrado
authors.initials: C
authors.lastname: Moiraghi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montrucchio
authors.forename: Enrico
authors.initials: E
authors.lastname: Lupia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D004636:Emergency Service, Hospital; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult