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VOLUME 22 , ISSUE 10 ( 2018 ) > List of Articles


Spectrum of diseases/conditions exhibiting hemostatic abnormalities in patients admitted to a medical intensive care unit of a tertiary care hospital

Girish Rajadhyaksha, Ameena Meah

Keywords : Acute Physiology and Chronic Health Evaluation II score, bleeding, intensive care unit, transfusion, tropical diseases

Citation Information : Rajadhyaksha G, Meah A. Spectrum of diseases/conditions exhibiting hemostatic abnormalities in patients admitted to a medical intensive care unit of a tertiary care hospital. Indian J Crit Care Med 2018; 22 (10):711-717.

DOI: 10.4103/ijccm.IJCCM_505_17

License: CC BY-ND 3.0

Published Online: 01-09-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Background and Aims: In a medical intensive care unit (MICU), many patients develop hemostatic abnormalities, ranging from abnormal clotting tests to frank bleeding. The aim of this study was to assess the etiology of diseases that present with bleeding, its common bleeding manifestations, incidence, MICU stay, mortality, and transfusion requirements in an Indian setup and also to assess if the Acute Physiology and Chronic Health Evaluation II (APACHE II) score can be used as a predictor for blood transfusion requirements. Materials and Methods: Between July 2013 and August 2014, 200 patients with clinically significant bleeding admitted in the MICU were prospectively evaluated. Detailed history, examination, laboratory investigations, APACHE II score, and requirement of blood products were also noted. The endpoints were discharge or death. Results: The spectrum of diseases that presented with bleeding was 47 patients with malaria (23.5%) followed by 36 acute undifferentiated febrile illness (18.0%), 33 dengue (16.5%), 30 leptospirosis (15.0%), 31 acute fulminant hepatitis (15.5%), 14 sepsis (7.0%), and the rest nine miscellaneous causes. The most common bleeding manifestation observed was hematuria in 62/200 (31%). Among the patients studied, 126 expired (63%) and 74 survived (37%). Of the 200 patients, 48/200 (24%) received packed cells, 78/200 (39%) fresh frozen plasma, and 82/200 (41%) platelets. Conclusions: Tropical diseases formed the majority of admissions with bleeding manifestations. Thrombocytopenia is an important marker to predict mortality and also has a significant association with MICU stay. APACHE II score was found to be a good predictor of blood transfusion requirements.

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  1. Collins English Dictionary – Complete & Unabridged. 10th ed. 2010.
  2. Rice TW, Wheeler AP. Coagulopathy in critically ill patients: Part 1: Platelet disorders. Chest 2009;136:1622-30.
  3. Wheeler AP, Rice TW. Coagulopathy in critically ill patients: Part 2-soluble clotting factors and hemostatic testing. Chest 2010;137:185-94.
  4. Chakraverty R, Davidson S, Peggs K, Stross P, Garrard C, Littlewood TJ, et al. The incidence and cause of coagulopathies in an intensive care population. Br J Haematol 1996;93:460-3.
  5. Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis 1970;3:282-98.
  6. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003;31:1250-6.
  7. Phuong HL, de Vries PJ, Nagelkerke N, Giao PT, Hung le Q, Binh TQ, et al. Acute undifferentiated fever in Binh Thuan Province, Vietnam: Imprecise clinical diagnosis and irrational pharmaco-therapy. Trop Med Int Health 2006;11:869-79.
  8. Arnold DM, Donahoe L, Clarke FJ, Tkaczyk AJ, Heels-Ansdell D, Zytaruk N, et al. Bleeding during critical illness: A prospective cohort study using a new measurement tool. Clin Invest Med 2007;30:E93-102.
  9. Mercer KW, Gail Macik B, Williams ME. Hematologic disorders in critically ill patients. Semin Respir Crit Care Med 2006;27:286-96.
  10. Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG, et al. Thrombocytopenia in patients in the medical Intensive Care Unit: Bleeding prevalence, transfusion requirements, and outcome. Crit Care Med 2002;30:1765-71.
  11. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med 2000;28:1871-6.
  12. Sharma B, Sharma M, Majumder M, Steier W, Sangal A, Kalawar M, et al. Thrombocytopenia in septic shock patients – A prospective observational study of incidence, risk factors and correlation with clinical outcome. Anaesth Intensive Care 2007;35:874-80.
  13. Baughman RP, Lower EE, Flessa HC, Tollerud DJ. Thrombocytopenia in the Intensive Care Unit. Chest 1993;104:1243-7.
  14. Levi M, Opal SM. Coagulation abnormalities in critically ill patients. Crit Care 2006;10:222.
  15. Matsuda T. Clinical aspects of DIC – Disseminated intravascular coagulation. Pol J Pharmacol 1996;48:73-5.
  16. Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol 2009;145:24-33.
  17. Hasegawa N, Husari AW, Hart WT, Kandra TG, Raffin TA. Role of the coagulation system in ARDS. Chest 1994;105:268-77.
  18. Dorinsky PM, Gadek JE. Mechanisms of multiple nonpulmonary organ failure in ARDS. Chest 1989;96:885-92.
  19. Misra DP, Das S, Pattnaik M, Singh SC, Jena RK. Relationship of hepatic and renal dysfunction with haemorrheological parameters in Plasmodium falciparum malaria. J Assoc Physicians India 2011;59:552-6.
  20. Gupta D, Ramanathan RP, Aggarwal AN, Jindal SK. Assessment of factors predicting outcome of acute respiratory distress syndrome in North India. Respirology 2001;6:125-30.
  21. Limaye CS, Londhey VA, Nabar ST. The study of complications of vivax malaria in comparison with falciparum malaria in Mumbai. J Assoc Physicians India 2012;60:15-8.
  22. Acharya SK, Dasarathy S, Kumer TL, Sushma S, Prasanna KS, Tandon A, et al. Fulminant hepatitis in a tropical population: Clinical course, cause, and early predictors of outcome. Hepatology 1996;23:1448-55.
  23. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in Intensive Care Units. French ICU Group for Severe Sepsis. JAMA 1995;274:968-74.
  24. Lauzier F, Cook D, Griffith L, Upton J, Crowther M. Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 2007;35:1655-9.
  25. Rao MP, Boralessa H, Morgan C, Soni N, Goldhill DR, Brett SJ, et al. Blood component use in critically ill patients. Anaesthesia 2002;57:530-4.
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