Case Reports

How to Manage Thrombocytopenia with ECLS: A Proposal of Clinical Reasoning Tools

^* Département d'Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
^† Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France
^‡ Département d'Hématologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France; and
^§ INSERM, UMR_1148, Paris, France

Address correspondence to: Adrien Koeltz, MD, Département d'Anesthésie-Réanimation, APHP, Hôpital Bichat-Claude Bernard, 46 Rue Henri Huchard, Paris 75877, France. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received: 1 August 2018
Accepted: 25 September 2018

Abstract

Extracorporeal life support (ECLS) is increasingly used as a rescue therapy in patients with refractory cardiac/respiratory failure for temporary support or bridge to decision-making in both adult and pediatric patients. Complications such as bleeding and thrombosis remain major causes of morbidity and mortality in patients treated with ECLS. Hemostatic complications related to ECLS are multifactorial in patients with multiple organ dysfunctions and are incompletely characterized. Persisting thrombocytopenia and/or platelet dysfunction is the most frequent one. Herein, we report the case of a patient who developed severe thrombocytopenia after 5 days of ECLS associated with thrombi deposition in the circuit and oxygenator. After ECLS circuit and membrane change, we observed an increase and normalization in platelet count in 3 days. We propose a case-based reasoning to manage thrombocytopenia with ECLS.