Practical approach to thrombocytopenia in patients with sepsis: a narrative review

作者：Kasumi Satoh, Takeshi Wada, Akihito Tampo, Gaku Takahashi, Kota Hoshino, Hironori Matsumoto, Takayuki Taira, Satoshi Kazuma, Takamitsu Masuda, Takashi Tagami, Hiroyasu Ishikura, J-STAD (JAPAN Sepsis Treatment and Diagnosis) Study Group, Takayuki Ogura, Yu Kawazoe, Yudai Takatani, Chie Tanaka, Kensuke Nakamura, Yoshihiko Nakamura, Katsunori Mochizuki, Maiko Yamazaki · 发表于：Thrombosis Journal · 年份：2024 · DOI：10.1186/s12959-024-00637-0 · 被引用次数：14 · 研究领域：Complement system in diseases、Blood Coagulation and Thrombosis Mechanisms、Mosquito-borne diseases and control

Thrombocytopenia frequently occurs in patients with sepsis. Disseminated intravascular coagulation (DIC) may be a possible cause of thrombocytopenia owing to its high prevalence and association with poor outcomes; however, it is important to keep the presence of other diseases in mind in sepsis practice. Thrombotic microangiopathy (TMA), which is characterized by thrombotic thrombocytopenic purpura, Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (HUS), and complement-mediated HUS, is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and organ damage. TMA has become widely recognized in recent years because of the development of specific treatments. Previous studies have reported a remarkably lower prevalence of TMA than DIC; however, its epidemiology is not well defined, and there may be cases in which TMA is not correctly diagnosed, resulting in poor outcomes. Therefore, it is important to differentiate DIC from TMA. Nevertheless, differentiating between DIC and TMA remains a challenge as indicated by previous reports that most patients with TMA can be diagnosed as DIC using the universal coagulation scoring system. Several algorithms to differentiate sepsis-related DIC from TMA have been suggested, contributing to improving the care of septic patients with thrombocytopenia; however, it may be difficult to apply these algorithms to patients with coexisting DIC and TMA, which has recently been reported. This review describes the disease c...