Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org

Trombocytophenia in sepsis


Recommended Posts

Some of my collegues use as treatment of trombrocytopenia (  exemple:10.000 platelets) in context of   severe sepsis (BLEE multiresistant) transfusions of platelets every 6-8 h, as routine treatment ( ??? ), like furosemida or cefotaxima or meropenem, without repeating hemogram.  I´m not agree, with this options.  What do yo think ? Is a good indication? Have you any guidelinnes?? Thank you

Link to post
Share on other sites

Thrombocytopenia in sepsis is due to increased platelets consumption and DIC. The megakaryocytes in bone marrow are normal and there is increased mean platelet volume.There could be some degree of bone depression as well. Platelets transfusions are part of  supportive therapy in severe sepsis.Checking the full blood count will be helpful as part of the general care for these babies. You need to see a trend of improvement or worsening of your blood counts.Your colleagues` rational is that the platelets are going to be consumed quickly and they want to minimize blood sampling.In severe sepsis, its better to monitor frequently the coagulation profile, CBC, CRP(if you routinely use it), electrolytes, blood gas, lactate and renal function.You might need to give FFP and cryopreciptate  if indicated.

Omer Hamud

Neonatal-Perinatal Medicine

Toronto, Canada

  • Upvote 1
Link to post
Share on other sites

Thank you Dr Hamud. I don´t undestand your replay. In this example ¿do yo use transfusion of platelets every 8 h? ¿do you check the full blood count every  4 or 6 or 8 h and depending on if trombocytopenia persist you use plapelets transfusion?.

And another question, please, you opinion about hemocompletan (fibrinogen) an protoplex (coagulations factor) in sepsis+ coagulophaty. Do you have any report or biblyography?

Again , thank you.

  • Upvote 1
Link to post
Share on other sites

@mmerocru, the point by @Omer is that decreasing blood counts are commonly seen in septicemia and transfusions of blood products are often needed.

 

I think the most important aspect here is to "follow the baby" and give what you consider needed as supportive care: to give platelets when the trombocytopenia becomes too bad or you see a steep/quick reduction, and to give erytrocyte transfusion when the Hb/EVF becomes too low (according to your local guidelines).

 

We do not use platelet transfusions as a routine therapy. But, in severe septicemia we generally check blood counts 2-3 times/24h. We have no fixed lower threshold for platelet transfusions but generally want to levels above 15-20 if the baby is very sick. When it comes to erytrocyte transfusions we generally aim for EVF ≥ 40%.

  • Upvote 1
Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...