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Table 1 Common causes of thrombocytopenia in critical care patients

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

Type Common causes
Decreased platelet production Severe infections (bacteria, viruses, fungi, parasites, etc.)
Bone marrow suppressionDrugs such as valproic acid, daptomycin, linezolid, and interferon
 Poisoning, such as ethanol
 Chemotherapy drugs
 Radiation therapy
 Chronic liver disease
Lack of nutrient substratesFolic acid and vitamin B12 deficiency
Hematological diseasesLeukemia, aplastic anemia (AA)
Increased platelet consumptionBleedingTraumatic coagulopathy, major gastrointestinal bleeding, cerebral hemorrhage
Severe infectionInfections 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 diseasesAcute fatty liver of pregnancy (AFLP)
Amniotic fluid embolism
Thrombotic diseaseSevere pulmonary embolism
Extracorporeal life support (ECLS)Extracorporeal membrane oxygenation (ECMO)
Renal replacement therapy (RRT)
Artificial liver support system (ALSS)
Auxiliary circulation deviceIntra-aortic balloon counterpulsation (IABP)
Ventricularassist device (VAD)
TMAThrombocytopenic purpura (TTP)
Hemolytic uremic syndrome (HUS)
Heat strokeExertional heat stroke (EHS)
 Von Willebrand disease (VWD)
Hematological diseasesHemophagocytic lymphohistiocytosis (HLH)
Autoimmune diseaseAPS, autoimmune hemolyticanemia (AIHA), Evan’s syndrome (AIHA + ITP)
Hyperfibrinolytic stateCirrhosis, metastatic prostate/ovarian tumors
Increased platelet destructionSevere infectionDengue
 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 diseaseSystemic lupus erythenlatosus (SLE), rheumatoid arthritis (RA)
Abnormal platelet distributionHematological diseasesPrimary immune thrombocytopenia (ITP)
 Posttransfusion purpura (PTP)
Low temperature 
HemodilutionMassive rehydration or plasma transfusion