A study to evaluate the prognostic significance of thrombocytopenia among critically ill children

Authors

  • Suneel C. Mundkur Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
  • Ranjani Upadhyay Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
  • Shrikiran A. Hebbar Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
  • Pushpa Kini Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
  • Nalini Bhaskarananda Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India
  • Sowmya Shashidhara Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20190428

Keywords:

Outcome, Pediatrics intensive care unit, Platelet counts, Platelet course, Prognosis, Thrombocytopenia

Abstract

Background: Pediatric critical care differs from Adult critical care not only in age but also in the outcomes. There are no studies regarding thrombocytopenia in the pediatric population. Therefore, in the current study, our objective was to study the prevalence and, the severity of thrombocytopenia, clinical features, and prognostic significance of low platelet count as an independent predictor of mortality and prolonged hospital and ICU stay.

Methods: This was a prospective observational study conducted at tertiary care paediatric intensive care unit in India. Children between 1 month to 18 years admitted to the Pediatrics intensive care unit with thrombocytopenia due to any cause at admission were involved in the study. Detailed history was documented. Haemoglobin levels, total leucocyte counts, platelet counts, and platelet indices were recorded on the first and fourth day of admission. Outcomes were analysed in term of survivors and non-survivors and duration of ICU and hospital stay.

Results: The study group consisted of 150 children with mean age of 8.458(± 5.604) years. Majority of children in the study group had severe thrombocytopenia 77 (51.3%). Moderate and mild thrombocytopenia was seen in 35(23.3%) and 38(25.4%) children respectively. Infection (50.66%) was the most common cause of thrombocytopenia, followed by sepsis (10.66%). Sepsis (27.5%) was observed to be the most common cause of mortality. Rise in platelet count on the fourth day among survivors, and no survivors were observed in 79.1% and 15.9% respectively.  Failure of the rise in platelet count on the fourth day of admission was significantly associated with mortality (p value=0.001). The severity of thrombocytopenia does not correlate with duration of hospital and ICU stay.

Conclusions: Platelet counts and indices at the time of admission to a critical care unit have limited use as a prognostic marker for predicting mortality in children.

References

Nurden AT. Platelets, inflammation and tissue regeneration. Thrombosis Haemostasis. 2011;105(S 06):S13-33.

Kaur A, Sethi GK, Goyal RK, Kaur A, Kaur R, Dhir SK, et al. Thrombocytopenia in paediatric ICU: Incidence, transfusion requirement and role as prognostic indicator. J Clinical Diagnostic Research: JCDR. 2015;9(12):SC05.

Vasu BK, Sinha R, Verghese S. Thrombocytopenia and guideline‐evaluated appropriateness of platelet transfusion in a tertiary care intensive care unit. ISBT Sci Series. 2016;11(2):102-9.

Arnold DM, Crowther MA, Cook RJ, Sigouin C, Heddle NM, Molnar L, et al. Utilization of platelet transfusions in the intensive care unit: indications, transfusion triggers, and platelet count responses. Transfusion. 2006;46(8):1286-91.

British Committee for Standards in Haematology, Blood Transfusion Task Force (Chairman P. Kelsey). Guidelines for the use of platelet transfusions. British J Haematol. 2003;122(1):10-23.

Du Pont-Thibodeau G, Tucci M, Robitaille Tucci, Marisa MD, FRCPC, FAAP, et al. Platelet transfusions in pediatric intensive care. Pediat Critical Care Med. 2016;17(9):e420-9.

Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology: The Education Program of the American Society of Hematology. 2010;2010:135-43.

Thachil J, Warkentin TE. How do we approach thrombocytopenia in critically ill patients?. British J Haematol. 2017;177(1):27-38.

Lieberman L, Bercovitz RS, Sholapur NS, Heddle NM, Stanworth SJ, Arnold DM. Platelet transfusions for critically ill patients with thrombocytopenia. Blood. 2014;123(8):1146-51.

Gibson BE, Todd A, Roberts I, Pamphilon D, Rodeck C, Bolton-Maggs P, et al. Transfusion guidelines for neonates and older children. British J Haematol. 2004;124(4):433.

Agrawal S, Sachdev A, Gupta D, Chugh K. Platelet counts and outcome in the pediatric intensive care unit. Indian J Critical Care Med. 2008;12(3):102-8.

Akca S, Haji-Michael P, De Mendonça A, Suter P, Levi M, Vincent JL. Time course of platelet counts in critically ill patients. Critical Care Med. 2002;30(4):753-6.

Nijsten MW, ten Duis HJ, Zijlstra JG, Porte RJ, Zwaveling JH, Paling JC. Blunted rise in platelet count in critically ill patients is associated with worse outcome. Critical Care Med. 2000;28(12):3843-6.

Russul F. Mussa,Adeba A. Al- Al-Alyasiri, Jasim M. Al-Marzoki. Prognostic Value of Platelet Count in Paediatric Intensive Care Unit. Med J Babylon. 2012;9(4):9.

Moreau D, Vesin A, Garrouste-Orgeas M, de Lassence A, Zahar JR, Adrie C, et al. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest. 2007;131(6):1735-41.

Giovanetti TV, do Nascimento AJ, de Paula JP. Platelet indices: laboratory and clinical applications. Rev Bras Hematol Hemoter. 2011;33(2):164-5.

Farias MG, Schunck EG, Dal Bó S, de Castro SM. Definition of reference ranges for the platelet distribution width (PDW): a local need. Clinical Chemistry Lab Med. 2010;48(2):255-7.

Parker RI. Transfusion in critically ill children: indications, risks, and challenges. Critical Care Med. 2014;42(3):675-90.

Krishnan J, Morrison W, Simone S, Ackerman A. Implications of thrombocytopenia and platelet course on pediatric intensive care unit outcomes. Pediat Critical Care Med. 2008;9(5):502-5.

Brugnara C. Appendices Reference Values in Infancy and Childhood. In: Stuart H. Orkin MD DEFM, PhD, David Ginsburg MD, A. Thomas Look MD, Samuel E. Lux MD and David G. Nathan MD, eds. Nathan and Oski's Hematology and Oncology of Infancy and Childhood. 8th ed. Philadelphia: Elsevier; 2015:2484-2535.

Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Critical Care Med. 2000;28(6):1871-6.

Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Critical Care Med. 2002;30(8):1765-71.

Vinayak K Patki, Vidya V. Patki. Decline in platelet count as a prognostic marker in critically ill children. J Pediat Critical Care. 2014;1(2):8.

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Published

2019-02-23

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Original Research Articles