Vnitr Lek 2010, 56(Suppl 1):14-26

Differential diagnosis of thrombocytopaenia in critically ill patients

J. Gumulec1,*, R. Kula2, O. Šimetka3, L. Pleva4, J. Ullrychová5
1 Ústav klinické hematologie FN Ostrava, přednosta prim. MUDr. Jaromír Gumulec
2 Anesteziologicko-resuscitační klinika FN Ostrava, přednosta prim. MUDr. Jan Jahoda
3 Porodnicko-gynekologická klinika FN Ostrava, přednosta prim. MUDr. Ondřej Šimetka
4 Traumatologické centrum FN Ostrava, přednosta prim. doc. MUDr. Leopold Pleva, CSc.
5 Oddělení laboratoří a transfuzní služby Nemocnice Děčín, o. z., přednostka prim. MUDr. Jana Ullrychová

Many critically ill patients develop hemostatic abnormalities, ranging from isolated thrombocytopenia to complex defects, such as disseminated intravascular coagulation. New onset thrombocytopenia and multiple organ failure predicts poor outcome in critical illness. There are many causes for platelet count decline in critically ill patients and each of these may require specific therapeutic and supportive management. In recent years, new insights into the pathogenesis and clinical management of many hemostatic defects in critically ill patients have been accumulated and this knowledge is helpful in determining the optimal diagnostic and differential diagnostic strategy.

Keywords: thrombocytopenia; shock; sepsis; disseminated intravascular coagulation; drug-induced thrombocytopenia; immune thrombocytopenia; intensive care unit

Received: April 14, 2010; Published: February 1, 2010  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Gumulec J, Kula R, Šimetka O, Pleva L, Ullrychová J. Differential diagnosis of thrombocytopaenia in critically ill patients. Vnitr Lek. 2010;56(Supplementum 1):14-26.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Stephan F, Hollande J, Richard O et al. Thrombocytopenia in a surgical ICU. Chest 1999; 115: 1363-1370. Go to original source... Go to PubMed...
    2. Vanderschueren S, De Weerdt A, Malbrain M et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med 2000; 28: 1871-1876. Go to original source... Go to PubMed...
    3. Strauss R, Wehler M, Mehler K et al. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med 2002; 30: 1765-1771. Go to original source... Go to PubMed...
    4. Akca S, Haji-Michael P, de Mendonca A et al. Time course of platelet counts in critically ill patients. Crit Care Med 2002; 30: 753-756. Go to original source... Go to PubMed...
    5. Shalansky SJ, Verma AK, Levine M et al. Risk markers for thrombocytopenia in critically ill patients: a prospective analysis. Pharmacotherapy 2002; 22: 803-813. Go to original source... Go to PubMed...
    6. Crowther MA, Cook DJ, Meade MO et al. Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care 2005; 20: 348-353. Go to original source... Go to PubMed...
    7. Moreau D, Timsit JF, Vesin A et al. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest 2007; 131: 1735-1741. Go to original source... Go to PubMed...
    8. Hanes SD, Quarles DA, Boucher BA. Incidence and risk factors of thrombocytopenia in critically ill trauma patients. Ann Pharmacother 1997; 31: 285-289. Go to original source... Go to PubMed...
    9. Mercer KW, Gail Macik B, Williams ME. Hematologic disorders in critically ill patients. Semin Respir Crit Care Med 2006; 27: 286-296. Go to original source... Go to PubMed...
    10. Kinasewitz GT, Yan SB, Basson B et al. Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism. Crit Care 2004; 8: R82-R90. Go to original source... Go to PubMed...
    11. Nijsten MW, ten Duis HJ, Zijlstra JG et al. Blunted rise in platelet count in critically ill patients is associated with worse outcome. Crit Care Med 2000; 28: 3843-3846. Go to original source... Go to PubMed...
    12. Spahn DR, Cerny V, Coats TJ et al. Management of bleeding following major trauma: a European guideline. Crit Care 2007; 11: R17. Go to original source... Go to PubMed...
    13. Rebulla P, Finazzi G, Marangoni F et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. N Engl J Med 1997; 337: 1870-1875. Go to original source... Go to PubMed...
    14. Wandt H, Frank M, Ehninger G et al. Safety and cost effectiveness of a 10 × 109/L trigger for prophylactic platelet transfusions compared with the traditional 20 × 109/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia. Blood 1998; 91: 3601-3606. Go to original source...
    15. Schiffer CA, Anderson KC, Bennett CL et al. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19: 1519-1538. Go to original source... Go to PubMed...
    16. Stanworth SJ, Hyde C, Brunskill S et al. Platelet transfusion prophylaxis for patients with haematological malignancies: where to now? Br J Haematol 2005; 131: 588-595. Go to original source... Go to PubMed...
    17. Slichter SJ. Evidence-based platelet transfusion guidelines. Hematology Am Soc Hematol Educ Program 2007: 172-178. Go to original source... Go to PubMed...
    18. Tosetto A, Balduini CL, Cattaneo M et al. Management of bleeding and of invasive procedures in patients with platelet disorders and/or thrombocytopenia: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res 2009; 124: e13-e18. Go to original source... Go to PubMed...
    19. Cosmi B, Alatri A, Cattaneo M et al. Assessment of the risk of bleeding in patients undergoing surgery or invasive procedures: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res 2009; 124: e6-e12. Go to original source... Go to PubMed...
    20. Bernard GR, Vincent JL, Laterre PF et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344: 699-709. Go to original source... Go to PubMed...
    21. Bernard GR. Drotrecogin α (activated) (recombinant human activated protein C) for the treatment of severe sepsis. Crit Care Med 2003; 31 (1 Suppl): S85-S93. Go to original source... Go to PubMed...
    22. Hess JR, Brohi K, Dutton RP et al. The coagulopathy of trauma: a review of mechanisms. J Trauma 2008; 65: 748-754. Go to original source... Go to PubMed...
    23. Brohi K, Cohen MJ, Ganter MT et al. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg 2007; 245: 812-818. Go to original source... Go to PubMed...
    24. Niles SE, McLaughlin DF, Perkins JG et al. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma 2008; 64: 1459-1463; discussion 1463-1465. Go to original source... Go to PubMed...
    25. Brohi K, Singh J, Heron M et al. Acute traumatic coagulopathy. J Trauma 2003; 54: 1127-1130. Go to original source... Go to PubMed...
    26. MacLeod JB, Lynn M, McKenney MG et al. Early coagulopathy predicts mortality in trauma. J Trauma 2003; 55: 39-44. Go to original source... Go to PubMed...
    27. Ho AMKM, Dion PW. Are we giving enough coagulation factors during major trauma resuscitation? Am J Surg 2005; 190: 479-484. Go to original source... Go to PubMed...
    28. Brummel-Ziedins K, Whelihan MF, Ziedins EG et al. The resuscitative fluid you choose may potentiate bleeding. J Trauma 2006; 61: 1350-1358. Go to original source... Go to PubMed...
    29. Hess JR, Lawson JH. The coagulopathy of trauma versus disseminated intravascular coagulation. J Trauma 2006; 60: (6 Suppl): S12-S19. Go to original source... Go to PubMed...
    30. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma 2006; 60 (6 Suppl): S91-S96. Go to original source... Go to PubMed...
    31. Meng ZH, Wolberg AS, Monroe DM 3rd et al. The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J Trauma 2003; 55: 886-891. Go to original source... Go to PubMed...
    32. Wolberg AS, Meng ZH, Monroe DM 3rd et al. A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma 2004; 56: 1221-1228. Go to original source... Go to PubMed...
    33. Levi M. Disseminated intravascular coagulation. Crit Care Med 2007; 35: 2191-2195. Go to original source... Go to PubMed...
    34. Mavrommatis AC, Theodoridis T, Orfanidou A et al. Coagulation system and platelets are fully activated in uncomplicated sepsis. Crit Care Med 2000; 28: 451-457. Go to original source... Go to PubMed...
    35. Berkman N, Michaeli Y, Or R et al. EDTA-dependent pseudothrombocytopenia: a clinical study of 18 patients and a review of the literature. Am J Hematol 1991; 36: 195-201. Go to original source... Go to PubMed...
    36. Francois B, Trimoreau F, Vignon P et al. Thrombocytopenia in the sepsis syndrome: role of hemophagocytosis and macrophage colony-stimulating factor. Am J Med 1997; 103: 114-120. Go to original source... Go to PubMed...
    37. Stephan F, Thioliere B, Verdy E et al. Role of hemophagocytic histiocytosis in the etiology of thrombocytopenia in patients with sepsis syndrome or septic shock. Clin Infect Dis 1997; 25: 1159-1164. Go to original source... Go to PubMed...
    38. Drews RE. Critical issues in hematology: anemia, thrombocytopenia, coagulopathy, and blood product transfusions in critically ill patients. Clin Chest Med 2003; 24: 607-622. Go to original source... Go to PubMed...
    39. Zeerleder S, Voves C, Wuillemin WA. Comment on hemostatic markers and the sepsis-related organ failure assessment score in patients with disseminated intravascular coagulation in an intensive care unit by Okabayashi et al. Am J Hematol 2005; 79: 344. Go to original source... Go to PubMed...
    40. Levi M, Opal SM. Coagulation abnormalities in critically ill patients. Crit Care 2006; 10: 222. Go to original source... Go to PubMed...
    41. Rice TW, Wheeler AP. Coagulopathy in critically ill patients: part 1: platelet disorders. Chest 2009; 136: 1622-1630. Go to original source... Go to PubMed...
    42. Bone RC, Balk RA, Cerra FB et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644-1655. Go to original source... Go to PubMed...
    43. Levi M, Toh CH, Thachil J et al. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol 2009; 145: 24-33. Go to original source... Go to PubMed...
    44. Al-Mondhiry H. Disseminated intravascular coagulation: experience in a major cancer center. Thromb Diath Haemorrh 1975; 34: 181-193. Go to original source... Go to PubMed...
    45. Siegal T, Seligsohn U, Aghai E et al. Clinical and laboratory aspects of disseminated intravascular coagulation (DIC): a study of 118 cases. Thromb Haemost 1978; 39: 122-134. Go to original source... Go to PubMed...
    46. Fourrier F, Chopin C, Goudemand J et al. Septic shock, multiple organ failure, and disseminated intravascular coagulation. Compared patterns of antithrombin III, protein C, and protein S deficiencies. Chest 1992; 101: 816-823. Go to original source... Go to PubMed...
    47. Mesters RM, Mannucci PM, Coppola R et al. Factor VIIa and antithrombin III activity during severe sepsis and septic shock in neutropenic patients. Blood 1996; 88: 881-886. Go to original source...
    48. Faust SN, Levin M, Harrison OB et al. Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med 2001; 345: 408-416. Go to original source... Go to PubMed...
    49. Egi M, Morimatsu H, Wiedermann CJ et al. Non-overt disseminated intravascular coagulation scoring for critically ill patients: the impact of antithrombin levels. Thromb Haemost 2009; 101: 696-705. Go to original source... Go to PubMed...
    50. Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost 1980; 43: 28-33. Go to original source... Go to PubMed...
    51. Wilde J, Kitchen S, Kinsey S et al. Plasma D-dimer levels and their relationship to serum fibrinogen/fibrin degradation products in hypercoagulable states. Br J Haematol 1989; 71: 65-70. Go to original source... Go to PubMed...
    52. Wada H, Gabazza EC, Asakura H et al. Comparison of diagnostic criteria for disseminated intravascular coagulation (DIC): diagnostic criteria of the International Society of Thrombosis and Hemostasis and of the Japanese Ministry of Health and Welfare for overt DIC. Am J Hematol 2003; 74: 17-22. Go to original source... Go to PubMed...
    53. Neame PB, Kelton JG, Walker IR et al. Thrombocytopenia in septicemia: the role of disseminated intravascular coagulation. Blood 1980; 56: 88-92. Go to original source...
    54. Ten CH. Trombocytopenia: one of the markers of disseminated intravascular coagulation. Pathophysiol Haemost Thromb 2003; 33: 413-416. Go to original source... Go to PubMed...
    55. Taylor Jr. FB, Toh CH, Hoots WK et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86: 1327-1330. Go to original source... Go to PubMed...
    56. Toh CH, Hoots WK. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost 2007; 5: 604-606. Go to original source... Go to PubMed...
    57. Gando S, Wada H, Asakura H et al. Evaluation of new Japanese diagnostic criteria for disseminated intravascular coagulation in critically ill patients. Clin Appl Thromb Hemost 2005; 11: 71-76. Go to original source... Go to PubMed...
    58. Gando S, Iba T, Eguchi Y et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med 2006; 34: 625-631. Go to original source... Go to PubMed...
    59. Gando S, Saitoh D, Ogura H et al. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: results of a multicenter, prospective survey. Crit Care Med 2008; 36: 145-150. Go to original source... Go to PubMed...
    60. Sawamura A, Hayakawa M, Gando S et al. Application of the Japanese Association for Acute Medicine disseminated intravascular coagulation diagnostic criteria for patients at an early phase of trauma. Thromb Res 2009; 124: 706-710. Go to original source... Go to PubMed...
    61. Gando S, Saitoh D, Ogura H et al. Disseminated intravascular coagulation (DIC) diagnosed based on the Japanese Association for Acute Medicine criteria is a dependent continuum to overt DIC in patients with sepsis. Thromb Res 2009; 123: 715-718. Go to original source... Go to PubMed...
    62. Payne BA, Pierre RV. Pseudothrombocytopenia: a laboratory artifact with potentially serious consequences. Mayo Clin Proc 1984; 59: 123-125. Go to original source... Go to PubMed...
    63. Schrezenmeier H, Muller H, Gunsilius E et al. Anticoagulant-induced pseudothrombocytopenia and pseudoleucocytosis. Thromb Haemost 1995; 73: 506-513. Go to original source... Go to PubMed...
    64. Sachova L, Urgasova A, Gumulec J. Laboratory procedures following thrombocytopenia diagnosis. Vnitř Lék 2009; 55: 290-294. Go to PubMed...
    65. Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med 2007; 357: 580-587. Go to original source... Go to PubMed...
    66. Aster RH, Curtis BR, McFarland JG et al. Drug-induced immune thrombocytopenia: pathogenesis, diagnosis, and management. J Thromb Haemost 2009; 7: 911-918. Go to original source... Go to PubMed...
    67. George JN, Aster RH. Drug-induced thrombocytopenia: pathogenesis, evaluation, and management. Hematology Am Soc Hematol Educ Program 2009: 153-158. Go to original source... Go to PubMed...
    68. Warkentin TE, Chong BH, Greinacher A. Heparin-induced thrombocytopenia: towards consensus. Thromb Haemost 1998; 79: 1-7. Go to original source... Go to PubMed...
    69. Arepally GM,Ortel TL. Clinical practice. Heparin-induced thrombocytopenia. N Engl J Med 2006; 355: 809-817. Go to original source... Go to PubMed...
    70. Greinacher A. Heparin-induced thrombocytopenia. J Thromb Haemost 2009; 7: (Suppl 1): 9-12. Go to original source... Go to PubMed...
    71. Warkentin TE, Sheppard JA, Moore JC et al. Laboratory testing for the antibodies that cause heparin-induced thrombocytopenia: how much class do we need? J Lab Clin Med 2005; 146: 341-346. Go to original source... Go to PubMed...
    72. Lo GK, Juhl D, Warkentin TE et al. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006; 4: 759-75. Go to original source... Go to PubMed...
    73. Pouplard C, Gueret P, Fouassier M et al. Prospective evaluation of the '4Ts' score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia. J Thromb Haemost 2007; 5: 1373-1379. Go to original source... Go to PubMed...
    74. Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood 2005; 106: 2710-2715. Go to original source... Go to PubMed...
    75. Rota E, Bazzan M, Fantino G. Fondaparinux-related thrombocytopenia in a previous low-molecular-weight heparin (LMWH)-induced heparin-induced thrombocytopenia (HIT). Thromb Haemost 2008; 99: 779-781. Go to original source... Go to PubMed...
    76. Gao C, Boylan B, Bougie D et al. Eptifibatide-induced thrombocytopenia and thrombosis in humans require FcγRIIa and the integrin β3 cytoplasmic domain. J Clin Invest 2009; 119: 504-511. Go to original source... Go to PubMed...
    77. Kelton JG, Neame PB, Gauldie J et al. Elevated platelet-associated IgG in the thrombocytopenia of septicemia. N Engl J Med 1979; 300: 760-764. Go to original source... Go to PubMed...
    78. van der Lelie J, van der Plas-Van Dalen CM, von dem Borne AE. Platelet autoantibodies in septicaemia. Br J Haematol 1984; 58: 755-760. Go to original source... Go to PubMed...
    79. Stephan F, Cheffi MA, Kaplan C et al. Autoantibodies against platelet glycoproteins in critically ill patients with thrombocytopenia. Am J Med 2000; 108: 554-560. Go to original source... Go to PubMed...
    80. Mueller-Eckhardt C, Kayser W, Mersch-Baumert K et al. The clinical significance of platelet-associated IgG: a study on 298 patients with various disorders. Br J Haematol 1980; 46: 123-131. Go to original source... Go to PubMed...
    81. Kelton JG, Murphy WG, Lucarelli A et al. A prospective comparison of four techniques for measuring platelet-associated IgG. Br J Haematol 1989; 71: 97-105. Go to original source... Go to PubMed...
    82. Fabris F, Scandellari R, Randi ML et al. Attempt to improve the diagnosis of immune thrombocytopenia by combined use of two different platelet autoantibodies assays (PAIgG and MACE). Haematologica 2002; 87: 1046-1052. Go to PubMed...
    83. Cines DB, Liebman H, Stasi R. Pathobiology of secondary immune thrombocytopenia. Semin Hematol 2009; 46 (Suppl 2): S2-S14. Go to original source... Go to PubMed...
    84. Mayer SA, Aledort LM. Thrombotic microangiopathy: differential diagnosis, pathophysiology and therapeutic strategies. Mt Sinai J Med 2005; 72: 166-175.
    85. Nguyen TC, Carcillo JA. Bench-to-bedside review: thrombocytopenia-associated multiple organ failure - a newly appreciated syndrome in the critically ill. Crit Care 2006; 10: 235. Go to original source... Go to PubMed...
    86. Gando S. Microvascular thrombosis and multiple organ dysfunction syndrome. Crit Care Med 2010; 38 (2 Suppl): S35-S42. Go to original source... Go to PubMed...
    87. Allford SL, Hunt BJ, Rose P et al. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol 2003; 120: 556-573. Go to original source... Go to PubMed...
    88. Pereira A, Mazzara R, Monteagudo J et al. Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome: a multivariate analysis of factors predicting the response to plasma exchange. Ann Hematol 1995; 70: 319-323. Go to original source... Go to PubMed...
    89. Crowther MA, George JN. Thrombotic thrombocytopenic purpura: 2008 update. Cleve Clin J Med 2008; 75: 369-375. Go to original source... Go to PubMed...
    90. Sadler JE. Thrombotic thrombocytopenic purpura: a moving target. Hematology Am Soc Hematol Educ Program 2006: 415-420. Go to original source... Go to PubMed...
    91. Gasser C, Gautier E, Steck A et al. Hemolytic-uremic syndrome: bilateral necrosis of the renal cortex in acute acquired hemolytic anemia. Schweiz Med Wochenschr 1955; 85: 905-909. Go to PubMed...
    92. McCrae KR, Bussel JB, Mannucci PM et al. Platelets: an update on diagnosis and management of thrombocytopenic disorders. Hematology Am Soc Hematol Educ Program 2001: 282-305. Go to original source... Go to PubMed...
    93. Rath W, Fischer T. The diagnosis and treatment of hypertensive disorders of pregnancy: new findings for antenatal and inpatient care. Dtsch Arztebl Int 2009; 106: 733-738. Go to original source...
    94. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000; 183: S1-S22. Go to original source...
    95. Sainio S, Kekomaki R, Riikonen S et al. Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand 2000; 79: 744-749. Go to original source... Go to PubMed...
    96. McCrae KR, Samuels P, Schreiber AD. Pregnancy-associated thrombocytopenia: pathogenesis and management. Blood 1992; 80: 2697-2714. Go to original source...
    97. Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol 1990; 162: 311-316. Go to original source... Go to PubMed...
    98. Martin Jr. JN, Files JC, Blake PG et al. Plasma exchange for preeclampsia. I. Postpartum use for persistently severe preeclampsia-eclampsia with HELLP syndrome. Am J Obstet Gynecol 1990; 162: 126-137. Go to original source...
    99. Sibai BM, Ramadan MK, Usta I et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169: 1000-1006. Go to original source... Go to PubMed...
    100. Finazzi G. The Italian Registry of Antiphospholipid Antibodies. Haematologica 1997; 82: 101-105. Go to PubMed...
    101. Cuadrado MJ, Mujic F, Munoz E et al. Thrombocytopenia in the antiphospholipid syndrome. Ann Rheum Dis 1997; 56: 194-196. Go to original source... Go to PubMed...
    102. Cervera R, Piette JC, Font J et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002; 46: 1019-1027. Go to original source... Go to PubMed...
    103. Lim W. Antiphospholipid antibody syndrome. Hematology Am Soc Hematol Educ Program 2009: 233-239. Go to original source... Go to PubMed...
    104. Asherson RA, Cervera R, de Groot PG et al. Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines. Lupus 2003; 12: 530-534. Go to original source... Go to PubMed...
    105. Cervera R, Font J, Gomez-Puerta JA et al. Validation of the preliminary criteria for the classification of catastrophic antiphospholipid syndrome. Ann Rheum Dis 2005; 64: 1205-1209. Go to original source... Go to PubMed...
    106. Espinosa G, Bucciarelli S, Asherson RA et al. Morbidity and mortality in the catastrophic antiphospholipid syndrome: pathophysiology, causes of death, and prognostic factors. Semin Thromb Hemost 2008; 34: 290-294. Go to original source... Go to PubMed...
    107. Cohen AM, Cycowitz Z, Mittelman M et al. The incidence of pseudothrombocytopenia in automatic blood analyzers. Haematologia (Budap) 2000; 30: 117-121. Go to original source... Go to PubMed...
    108. Ledgerwood AM, Lucas CE. A review of studies on the effects of hemorrhagic shock and resuscitation on the coagulation profile. J Trauma 2003; 54 (5 Suppl): S68-S74. Go to original source... Go to PubMed...
    109. Verma AK, Levine M, Shalansky SJ et al. Frequency of heparin-induced thrombocytopenia in critical care patients. Pharmacotherapy 2003; 23: 745-753. Go to original source... Go to PubMed...
    110. Gettings EM, Brush KA, Van Cott EM et al. Outcome of postoperative critically ill patients with heparin-induced thrombocytopenia: an observational retrospective case-control study. Crit Care 2006; 10: R161. Go to original source... Go to PubMed...
    111. Kuitunen A, Suojaranta-Ylinen R, Raivio P et al. Heparin-induced thrombocytopenia following cardiac surgery is associated with poor outcome. J Cardiothorac Vasc Anesth 2007; 21: 18-22. Go to original source... Go to PubMed...

    Return to the content


    Vnitřní lékařství

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.