Low Platelet Count

[RNScott]

I had a 16 year old patient recently who was the victim of a GSW to the L groin. It lacerated his L femoral artery. The artery was repaired with a graft. I received him in the ICU and he developed compartment syndrome in his abdomen and L thigh. He ended up with an open abdomen and thigh with wound vacs in place. A couple days later his kidneys failed and he ended up on CRRT. His leg was dying although he had a good pulse in it. They did an AKA. He was still in critical condition when I left with high lactate and still on CRRT. The plan was to do a disarticulation in a few days. He had an extremely low platelet count, which bottomed out at 5,000 the morning of the AKA and he was given around 6- 6 packs of platelets to get his count up to 63,000 so he could go to surgery. By that night his count was back at 13,000 and when given a 6 pack went up to 25,000. No one could really figure out why his platelet count was so low and kept dropping down. This had gone on for several days of dropping and then getting platelets and coming up to about 20-30 and then right back down under 15,000. Some said that CRRT will chew up platelets but I have had other patients on CRRT that that was not a problem. Just wondering if anyone has any ideas why such a low platelet count that just kept dropping down even when given platelets.

[Dinith88]

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.

[caroladybelle, BSN, RN]

I agree with needing a hematologist on the case.

[whooha]

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.