Table 1 Common causes of thrombocytopenia in critical care patients

Decreased platelet production

Severe infections (bacteria, viruses, fungi, parasites, etc.)

Bone marrow suppression

Drugs such as valproic acid, daptomycin, linezolid, and interferon

Poisoning, such as ethanol

Chemotherapy drugs

Radiation therapy

Chronic liver disease

Lack of nutrient substrates

Folic acid and vitamin B12 deficiency

Pregnancy

Hematological diseases

Leukemia, aplastic anemia (AA)

Increased platelet consumption

Bleeding

Traumatic coagulopathy, major gastrointestinal bleeding, cerebral hemorrhage

Severe infection

Infections with bacteria (such as Helicobacter pylori), viruses, fungi, parasites, rickettsia, and borrelia; human immunodeficiency virus (HIV); hepatitis C; Epstein-Barr (EB) virus; mumps, measles, and rubella viruses; brucellosis; tick-borne diseases; and malaria.

Disseminated intravascular coagulation (DIC)

Acute DIC, such as shock, infection, and leukemia; chronic DIC, such as malignant tumors and aneurysm

Hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP)

Pregnancy-related diseases

Acute fatty liver of pregnancy (AFLP)

Amniotic fluid embolism

Eclampsia

Thrombotic disease

Severe pulmonary embolism

Extracorporeal life support (ECLS)

Extracorporeal membrane oxygenation (ECMO)

Renal replacement therapy (RRT)

Artificial liver support system (ALSS)

Auxiliary circulation device

Intra-aortic balloon counterpulsation (IABP)

Ventricularassist device (VAD)

TMA

Thrombocytopenic purpura (TTP)

Hemolytic uremic syndrome (HUS)

Heat stroke

Exertional heat stroke (EHS)

Von Willebrand disease (VWD)

Hematological diseases

Hemophagocytic lymphohistiocytosis (HLH)

PNH

Autoimmune disease

APS, autoimmune hemolyticanemia (AIHA), Evan’s syndrome (AIHA + ITP)

Hyperfibrinolytic state

Cirrhosis, metastatic prostate/ovarian tumors

Increased platelet destruction

Severe infection

Dengue

Classic drug-dependent antiplatelet antibodies, such as quinine

Drug-induced immune thrombocytopenia (DITP)

Hapten-induced antibodies, such as penicillin

Drug-specific antibodies, such as tirofiban, etibeptide, and abciximab

Drug-induced autoantibodies, such as levodopa and sulfa

Formation of immune complex, such as HIT

Autoimmune disease

Systemic lupus erythenlatosus (SLE), rheumatoid arthritis (RA)

Abnormal platelet distribution

Hematological diseases

Primary immune thrombocytopenia (ITP)

Posttransfusion purpura (PTP)

Hypersplenism

Low temperature

Hemodilution

Massive rehydration or plasma transfusion