Re: Low Platelet Count
As he had a GSW, did he perhaps have received large amounts of platelets previously in his treatment or at any prior time in his life? And were the platelets that he was receiving "single donor/pheresis" or "random donor"?
In hematology, our leukemics in Induction therapy will be transfused with multiple units of platelets because of extended bone marrow suppression. Some of them become "platelet refractory"....they either do not increment well or will actually drop their platelet counts after transfusion. Their bodies have become so sensitized to platelets, that they destroy them faster.
In hematology, we routinely limit platelet transfusions to counts of 10,000 or less, 20,000 if febrile or minimal bleeding. For procedures we try to get them to 50,000 but that is not always possible. But of course these parameters would probably not work for a postop pt.
Other options for prevention: premedding for platelet transfusions, using single donor/pheresis platelets, using irradiated, leukoreduced platelets...but again this is more prevention, and does not help as much if the pt is already sensitized.
For seriously platelet refractory pts, we use HLA matched (more closely matched) platelets, though these can be harder to come by. And in a few pts, when we are able, we have gotten pheresis units from a matched family member (rarely an option).
Fevers can also decrease platelet counts. As can DIC.
I would also consider the CRRT as a possibility.
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