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Chapter 24. Coagulopathies, Bleeding Disorders, and Blood Component Therapy

Karl W Thomas, MD, FCCP
DOI: 10.1378/critcare.21.24
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Sections

Objectives 
  • Discuss the incidence and clinical significance of thrombocytopenia and coagulopathy in the critically ill patient population.

  • Distinguish and initiate appropriate treatment for common causes of thrombocytopenia including heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, and immune thrombocytopenic purpura.

  • Identify and determine clinical response to common ICU clotting factor coagulopathies including disseminated intravascular coagulation and liver disease.

  • Discuss the clinical monitoring and management of patients with coagulopathy of massive transfusion.

  • Determine the appropriate clinical use and dose range for platelets, fresh-frozen plasma, and cryoprecipitate.

  • Discuss briefly the role of blood substitutes and adjunctive treatments including desmopressin acetate, prothrombin complex concentrates, and recombinant activated factor VII.

Synopsis 

Anemia, thrombocytopenia, and combined coagulopathies are common in patients in the ICU. These disorders rarely occur in isolation and are directly related to ICU outcomes. Rapid and efficient recognition of these disorders is essential to the provision of timely and appropriate care. These disorders require a systematic clinical approach based on examination of platelets and coagulation factor parameters. This chapter will review and apply basic laboratory testing including examination of coagulation times, fibrin levels, d-dimer levels, peripheral blood smear, and platelet count. Thrombocytopenias, disseminated intravascular coagulation, immune thrombocytopenic purpura, thrombotic thrombocytopenic purpura, heparin-induced thrombocytopenia, and massive transfusion will be reviewed with a focus on key identifying features. Finally, this chapter will review use of blood components including platelet, plasma, cryoprecipitate, and other blood products.

References

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