title: Mechanisms and etiologies of thrombocytopenia in the intensive care unit: impact of extensive investigations.
abstract: BACKGROUND
  Thrombocytopenia is common in the intensive care unit. Potential mechanisms and etiologies behind this phenomenon are multiple and often entangled. We assessed the effect of a systematic approach, using routinely available tests, on the proportion of patients in whom the mechanism (primary objective) and etiology (secondary objective) of thrombocytopenia in a mixed intensive care unit (ICU) could be identified.
  
  
  METHODS
  Before-and-after study of all patients with thrombocytopenia was used. 'Before' group had no intervention. New standard operating procedures for thrombocytopenia management were introduced. In the 'After' group, bone marrow aspiration; determination of fibrinogen dosage, prothrombin time, factor V, D-dimers; assay of fibrin monomers, ferritin, triglycerides, lactic acid dehydrogenase, aspartate transaminase, alanine aminotransferase, vitamin B12, folates, reticulocytes, haptoglobin, and bilirubin were performed.
  
  
  RESULTS
  In the Before group (n = 20), the mechanism (central, peripheral, or mixed) was identified in 10 % versus 83% in After group (n = 23) (p < 0.001) (48% peripheral, 35% mixed). Before intervention, ≥1 etiology was identified in 15% versus 95.7% in the After group (p < 0.001).
  
  
  CONCLUSIONS
  Systematic and extensive investigation using routine tests highlights the mechanisms and etiology of thrombocytopenia in most cases.
authors.affiliation: Service de réanimation polyvalente, Centre Hospitalier, Chalon sur Saone 71321, France.
authors.forename: Nadiejda
authors.initials: N
authors.lastname: Antier
authors.affiliation: Service de réanimation médicale, Centre Hospitalier Universitaire Le Bocage, 14, Rue Gaffarel, Dijon 21079, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
authors.affiliation: Service de réanimation polyvalente, Centre Hospitalier, Chalon sur Saone 71321, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Doise
authors.affiliation: Service de réanimation polyvalente, Centre Hospitalier, Chalon sur Saone 71321, France.
authors.forename: Robin
authors.initials: R
authors.lastname: Noel
authors.affiliation: Laboratoire d'hémostase, Centre Hospitalier Universitaire Le Bocage, Dijon 21079, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Demaistre
authors.affiliation: Service de médecine interne, Centre Hospitalier Universitaire Hôpital Général, Dijon 21079, France ; CIC-EC CHU de Dijon (INSERM CIE1), Dijon 21000, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Devilliers
keywords: Bone marrow aspiration; Intensive care unit; Thrombocytopenia