Low Platelet Count

Very interesting, and unfortunate. I had a similar problem this week. My patient however was an elderly patient that was put on CRRT (CVVH) for ARF. She too experienced a drop in her platelet count from about 150,000 to about 15,0000 she also had an developed an INR of 4.5, a PTT of about 45 and a fibrinogen of about 85.

Her coagulopathy did reverse after many blood products, however the cause remains a mystery. Thanks for sharing your story

Greg

Not uncommon in either ARF or CRRT (for any etiology) for some weird, unexplained coagulopathies to come into play. Have seen it many times...

since we dont have the chart to scour, and since there are a bazillion things that can cause thrombocytompenia, eyeryone here is simply throwing darts and guessing. This thread should more simply be called:
"what can cause thrombocytopenia?...and i've likely already thought of that".
So..anyway, this kids pretty sick and should have a hematologist on board...if not someone's screwing up.

Otherwise, since you've alreay ruled-out, DIC,TTP, HIT (man thats alot of letters..) two other simple explanations not yet mentioned in this case would be sepsis (his limbs are dying and his lactate is up, etc)...sepsis by itself can lower platelets. Another easy thing to blame is drugs..notably antibiotics which he's surely on a myriad.

But...those are just 2 more guesses in the barrel of guesses above this guessy-type post. Ask the hematologist...and inform us of his opinion. We can go from there and be a wee better informed.

I agree with needing a hematologist on the case.

This is just one more cause of Thrombocytopenia, but it was an issue with a patient I had a couple of weeks ago. He was a Sickle Cell patient that was intuited on CRRT, septic and in DIC. After he'd stabilized a bit he was still chewing through platelets. The hematologist finally said he'd infarcted his bone marrow and said that was the cause of his platelet issue. Thought it was interesting. One more cause to toss into the pot.