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Kidney Week

Abstract: PO0290

Continuous Renal Replacement Therapy: A Reversible Cause of Thrombocytopenia

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Goff, Megan Elizabeth, Medical University of South Carolina, Charleston, South Carolina, United States
  • McMahon, Blaithin A., Medical University of South Carolina, Charleston, South Carolina, United States
Introduction

Thrombocytopenia is frequently encountered in critically ill patients. Whether present on admission or acquired during hospitalization, inadequate platelet counts are an independent risk factor for patient morbidity and mortality in the Intensive Care Unit. Continuous renal replacement therapy is a lesser known cause of acquired thrombocytopenia.

Case Description

In this retrospective case series, four patients that developed thrombocytopenia while receiving continuous renal replacement therapy (CRRT) in the Intensive Care Unit were evaluated. The temporal relationship between onset of thrombocytopenia, timing of CRRT, and subsequent trend in platelet counts were analyzed. The patients had a variety of risk factors for thrombocytopenia including septic shock, presence of chronic kidney disease, mechanical support therapies, and anticoagulation with heparin. Despite these characteristics and interventions, each of the patients demonstrated a pronounced drop in platelet count within 72 hours of initiating CRRT, with a subsequent improvement in platelet count following cessation of CRRT.

Discussion

Thrombocytopenia is a complication of critical illness that, in extreme cases, can lead to further cost and resources to evalute and possibly delay necessary intervention. In patients requiring renal replacement therapy, clinicians must be cognizant that continuous modalities are a potential source of thrombocytopenia. Nephrologists are responsible for knowing all potential adverse outcomes of the procedure of dialysis. Educating other health team members of these risks is part of that responsibility.

Data
Hours since CRRT initiationPlatelet Count
Patient 1
(per microL)
Platelet Count
Patient 2
(per microL)
Platelet Count
Patient 3
(per microL)
Platelet Count
Patient 4
(per microL)
0225,000243,000225,00080,000
24138,000159,000112,00060,000
4897,00069,00077,00053,000
7271,00044,00058,00047,000
Hours since CRRT cessation    
013,00044,00083,00049,000
2443,00058,000129,00060,000
4854,00067,000176,00099,000

CRRT = Continuous Renal Replacement Therapy