Haematological problems in intensive care

Abstract 

Anaemia, thrombocytopenia and coagulation problems are common haematological abnormalities encountered regularly in intensive care units (ICUs). The causes of all are multifactorial, making diagnosis of the problem difficult. The causes of anaemia range from blood loss to myelosuppression. Various studies have shown that lower haemoglobin (Hb) threshold levels (7 g/dl) for transfusion are appropriate and even safer than higher levels in haemodynamically stable patients. However, the transfusion trigger should be decided in individual patients depending on their comorbidities. Every effort should be made to find and treat the cause of thrombocytopenia, which may be life-threatening and is, in itself, a poor prognostic feature in ICU patients. Sepsis and drugs are the most frequently encountered causes of thrombocytopenia. Management should include treatment of the underlying cause, together with platelet transfusion, which may be life-saving but also contraindicated in some causes of significant thrombocytopenia. Coagulation defects range from simple abnormal clotting tests to frank disseminated intravascular coagulation (DIC). Prothrombin time (PT) and activated partial thromboplastin time (APTT) are the most commonly performed tests to screen for causes of bleeding. However, they are not wholly predictive of the bleeding diathesis. Management of coagulation abnormalities is to treat the underlying cause and in the bleeding patient to consider the use of blood products such as fresh frozen plasma (FFP) or a prothrombin complex concentrate (PCC).

Keywords: anaemia, coagulation problems, critical care, DIC, FFP, haematological problems, intensive care, platelets, red-blood-cell transfusion, thrombocytopenia