IBCC Episode 22 - Thrombocytopenia

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam Thomas discuss thrombocytopenia and heparin-induced thrombocytopenia (HITT) in ICU patients. They cover the differential diagnosis of thrombocytopenia, distinguishing between subacute/chronic, non-immune consumption, and immune consumption causes. They emphasize the importance of identifying drug-induced thrombocytopenia and the appropriate use of platelet transfusions, including indications and contraindications. The hosts delve into the pathogenesis, diagnosis, and management of HITT, highlighting the utility of the 4T score and Bayesian analysis for risk stratification. They also discuss empiric anticoagulation strategies and the use of non-heparin anticoagulants like Argatraban and Fondoparanox. The episode concludes with a systematic approach to investigating thrombocytopenia, including chart review, core investigations, and immediate management steps, while cautioning against the over-reliance on fixed platelet transfusion targets.