Critical care clinics
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Critical care clinics · Jul 2012
ReviewThe utility of a diagnostic scoring system for disseminated intravascular coagulation.
Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by microvascular thrombosis resulting from systemic activation of coagulation, and it should be diagnosed and treated as early as possible. No single test is sufficiently accurate to establish or rule out a diagnosis of DIC. ⋯ Three diagnostic scoring systems are now available and validated. Because it is not easy to assess the superiority or inferiority of these scoring systems, it may be better to select the scoring system depending on the need for an early or affirmative diagnosis of DIC.
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Critical care clinics · Jul 2012
ReviewThe use of erythropoiesis-stimulating agents in the intensive care unit.
Anemia is common in critically ill patients, but treatment with red blood cell transfusions can have unwanted effects. Limiting the occurrence and severity of anemia by using erythropoietic agents (iron and/or recombinant erythropoietin), therefore, remains an attractive option during the intensive care unit stay but also after hospital discharge. Moreover, these agents may have additional beneficial properties. In this article the authors review the rationale for the administration of iron and/or erythropoietin in critically ill patients.
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Critical care clinics · Jul 2012
ReviewIntensive care unit management of liver-related coagulation disorders.
Coagulopathy, one of the cardinal features of advanced liver disease, is related to multiple factors including impaired synthetic function, thrombocytopenia, excessive fibrinolysis, platelet dysfunction, and disseminated intravascular coagulopathy. In the intensive care unit, management of coagulopathy may require treatment, particularly in the actively bleeding patient or in preparation for invasive procedures. This article reviews the background of coagulopathy in patients with end-stage liver disease and management options and comments on common clinical scenarios.
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Critical care clinics · Jul 2012
ReviewEtiology and significance of thrombocytopenia in critically ill patients.
Thrombocytopenia is common in critically ill patients and increases morbidity and mortality. A diagnosis of heparin-induced thrombocytopenia (HIT) is frequently considered in any ICU patient who develops thrombocytopenia in the context of ongoing heparin exposure. As the usual tests to diagnose HIT are often neither specific nor sensitive enough to be confirmatory, the intensivist must largely rely on clinical judgment in treatment decisions. Patients in the ICU may also develop thrombocytopenia resulting from non-HIT immune mechanisms, nonimmune platelet consumption, and from decreased platelet production due to preexisting disorders or as a result of their critical illness and/or drug therapy.