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      Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

      research-article
      Author(s): 1 , , 2 , 3 , 4 , 5 , 6 , , 7 , , on behalf of the Critical Care Medicine Committee of Chinese People’s Liberation Army (PLA); Chinese Society of Laboratory Medicine, Chinese Medical Association
      Publication date (Electronic):
      Journal: Military Medical Research
      Publisher: BioMed Central
      Keywords: Thrombocytopenia, Adult, Critical care, Diagnosis, Treatment, Expert consensus

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          Abstract

          Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People’s Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.

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          Most cited references171

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          Diagnosis and Management of the Antiphospholipid Syndrome

          David Vállez Garcia, Dan L Longo, Doruk Erkan (2018)
          Article 0 comments Cited 199 times – based on 0 reviews     Review now
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            Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue.

            Joseph Schwartz, Anand Padmanabhan, Nicole A Aqui … (2016)
            The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
            Article 0 comments Cited 195 times – based on 0 reviews     Review now
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              American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia

              Adam Cuker, Gowthami Arepally, Beng Chong … (2018)
              Background: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction mediated by platelet-activating antibodies that target complexes of platelet factor 4 and heparin. Patients are at markedly increased risk of thromboembolism. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about diagnosis and management of HIT. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 33 recommendations. The recommendations address screening of asymptomatic patients for HIT, diagnosis and initial management of patients with suspected HIT, treatment of acute HIT, and special situations in patients with acute HIT or a history of HIT, including cardiovascular surgery, percutaneous cardiovascular intervention, renal replacement therapy, and venous thromboembolism prophylaxis. Conclusions: Strong recommendations include use of the 4Ts score rather than a gestalt approach for estimating the pretest probability of HIT and avoidance of HIT laboratory testing and empiric treatment of HIT in patients with a low-probability 4Ts score. Conditional recommendations include the choice among non-heparin anticoagulants (argatroban, bivalirudin, danaparoid, fondaparinux, direct oral anticoagulants) for treatment of acute HIT.
              Article 0 comments Cited 164 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jing-Chun Song: songjingchun@126.com
                Shu-Yuan Liu: liusydoc@163.com
                Feng Zhu: alexzhujunchi@hotmail.com
                Ai-Qing Wen: dpyysxkwaq@hotmail.com
                Lin-Hao Ma: macro118@hotmail.com
                Wei-Qin Li: liweiqindr@vip.163.com
                Jun Wu: wujunpostbox@sina.com
                Journal
                Journal ID (nlm-ta): Mil Med Res
                Journal ID (iso-abbrev): Mil Med Res
                Title: Military Medical Research
                Publisher: BioMed Central (London )
                ISSN (Print): 2095-7467
                ISSN (Electronic): 2054-9369
                Publication date (Electronic): 3 April 2020
                Publication date PMC-release: 3 April 2020
                Publication date Collection: 2020
                Volume: 7
                Electronic Location Identifier: 15
                Affiliations
                [1 ]Department of Critical Care Medicine, the 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, 360104 China
                [2 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Emergency Department, , the Sixth Medical Center, Chinese PLA General Hospital, ; Beijing, 100048 China
                [3 ]GRID grid.411525.6, ISNI 0000 0004 0369 1599, Burns and Trauma ICU, Changhai Hospital, , Naval Medical University, ; Shanghai, 200003 China
                [4 ]GRID grid.414048.d, ISNI 0000 0004 1799 2720, Department of Blood Transfusion, , Daping Hospital of Army Medical University, ; Chongqing, 400042 China
                [5 ]GRID grid.413810.f, Department of Emergency and Critical Care Medicine, Changzheng Hospital, , Naval Medical University, ; Shanghai, 200003 China
                [6 ]GRID grid.41156.37, ISNI 0000 0001 2314 964X, Surgery Intensive Care Unit, Jinling Hospital, , Medical School of Nanjing University, ; Nanjing, 210002 China
                [7 ]GRID grid.414360.4, Department of Clinical Laboratory, , Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, ; Beijing, 100035 China
                Article
                Publisher ID: 244
                DOI: 10.1186/s40779-020-00244-w
                PMC ID: 7118900
                PubMed ID: 32241296
                SO-VID: ad12a0d0-1d92-43e8-ac72-ff13ac630af2
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 12 March 2020
                Date accepted : 20 March 2020
                Categories
                Subject: Position article and Guidelines
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: thrombocytopenia,adult,critical care,diagnosis,treatment,expert consensus
                Data availability:
                Keywords: thrombocytopenia, adult, critical care, diagnosis, treatment, expert consensus

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