Optimization of thrombocytopenia correction on the example of leptospirosis
The objective. Is to improve the approach to platelet concentrate transfusion depending on the pathogenetic type of thrombocytopenia using leptospirosis as an example.
Patients and methods. The study included patients (n = 31) with laboratory-confirmed leptospirosis. There were two comparison groups. First was the group with the platelet concentrate transfusion (16 survivors / 4 dead). Second group was without platelet concentrate transfusion (7 survivors / 4 dead). Groups are comparable by the main indicators of hemostasis and severity parameters of multiple organ failure. The indirect effect of platelet concentrate transfusion on trombocytopoesis was evaluated using platelet indices (MPV and PDW). Survival analysis was made using Kaplan-Meyer method with a Cox
proportional intensity model. Relative risk (RR) was calculated with a 95% confidence interval (CI).
Results. After platelet concentrate transfusion, platelet count is statistically significantly increasing without suppression of thrombocytopoesis. But platelet concentrate transfusion does not affect the survival of patients with leptospirosis and does not prevent bleeding. Indications for platelet concentrate transfusion are: 1) thrombocytopenia <20 × 109/l with reliable diagnosis of DIC with consumption coagulopathy or with other hemostasis disorders with obligatory active life-threatening bleeding at the time of platelet concentrate transfusion 2) persistent >24 hours thrombocytopenia 20–50 × 109/l with active bleeding and/or with thrombocytopathya.
Conclusion. The principle of a strictly limited approach to platelet replacement therapy for the patients with leptospirosis was formulated.
Key words: survival, leptospirosis, thrombocytopenia, platelet concentrate.
For citation: Gorodin V.N., Moysova D.L. Optimization of thrombocytopenia correction on the example of leptospirosis. Infekc. bolezni (Infectious diseases). 2019; 17(4): 34–40. (In Russian).