Introduction: the thrombocytopenia is the most frequent haemostatic in the critically ill population, where mechanisms and causes are often multiple, with a predominance of the peripheral causes.
It is responsible for an important morbi-mortality: a more important risk of bleeding, prolonged hospitalization and a higher mortality rate. And it is an independent prognostic factor.
The goal of the work: study the epidemiological, clinical aspects, the incidence, the associated factors, the causes and the morbimortality related to the thrombocytopenia in the ICU.
Material and methods: This is a retrospective study, concerning all the patients who presented a thrombocytopenia in the ICU A4 of the CHU Hassan II of Fez over a period of 18 months
January1st2011-June30th2012 .
All the patients who are older than 16years and who presented thrombocytopenia were included in this study. The patients having remained less than 24 hours, or having histories of blood disease, the patients having recently benefited from chemotherapy and the false thrombocytopenia were excluded from this study.
Results: during this period, 1300 patients were hospitalized in the ICU A4 in the CHU Hassan II of Fez.
750 patients only met the criteria of inclusion, which 350 presented a thrombocytopenia, that is a global frequency of 47 %. The average age of the patients was of 48 years with extremes ranging from 16 to 90 with and a male ascendancy (60 %). The length of hospital stay for the patients with thrombocytopenia was 7.6 days compared to the patients without thrombocytopenia was 4.2 days, with extremes going
from 2 to 31.
The scores of gravity were more raised at the patients with thrombocytopenia compared to the patients without thrombocytopenia,
(IGS II in 21,4 vs 15 and a score of SOFA of 2 vs 1). The average platelet count at was 95.000 / mm3 with extremes going from 4000 to 149 .000 / mm3.67 patients, that is 9 % of the cases had a platelet count less than 50000 /mm3.
The main factors associated with thrombocytopenia were : patients with a high score IGS II, the bleeding, the notion of trauma, the SDRA, The hemodynamic instability, the presence of a central venous catheter, the renal failure, increased bilirubine, a rate of prothrombine low, a massive transfusion and especially the presence of a sepsis
The main causes found in our study are the sepsis (56 %) and the bleeding (25 %). The drug induced thrombocytopenia is rarer (1 %), this low incidence can be explained by the retrospective character of the study and the entanglement of several factors at the same patient.
The mortality rate at the patients with thrombocytopenia was 40 %. Compared to the patients without 16,25%
Conclusion: this study confirms the pejorative character of the thrombocytopenia in resuscitation and underlines the importance of establishing a clear and simple protocol to thrombocytopenia and the need of a prospective study in the future.