Famotidine thrombocytopenia

Reversible neutropenia and thrombocytopenia during famotidine treatment. Oymak O, Akpolat T, Arik N, Yasavul U, Turgan C, Caglar S. Ann Pharmacother, …Aster RH, Bougie DW. Current Concepts: Drug-induced Thrombocytopenia. New Engl J Med 2007 357: 580-587. Kuter DJ.Thrombopoietin and thrombopoietin mimetics in the treatment of thrombocytopenia. Annu Rev Med. 2009;60:193-206. Jul 24, 2023 · Pathologic elevation of conjugated or direct bilirubin (concentration higher than 2 mg/dL or more than 20% of total bilirubin) is termed conjugated hyperbilirubinemia.[1] It is a biochemical marker of cholestasis and hepatocellular dysfunction.[1] Approximately 80% of the bilirubin is derived from hemoglobin metabolism.[2] The breakdown of heme molecules in hemoglobin, myoglobin, cytochromes ... Possible famotidine-induced thrombocytopenia. Possible famotidine-induced thrombocytopenia DICP. 1989 Jun;23(6):507-8. doi: 10.1177/106002808902300615. Authors J B Comer, J A Evans, A Kerns. PMID: 2568035 DOI: 10.1177/106002808902300615 No abstract available. Publication types ...Famotidine is an acid-suppressing agent that may be used to treat a wide range of gastric-acid-related disorders including gastric ulcers, heartburn, and GERD. A headache is the most common side... more. Prescription only. Pantoprazole is a proton pump inhibitor that decreases acid secretion in the stomach and may be given to relieve the ...Famotidine Use and Thrombocytopenia in the Trauma Patient. Go to citation Crossref Google Scholar. Does Famotidine Induce Thrombocytopenia in Neurosurgical Patients? Go to citation Crossref Google Scholar. Management of gastrointestinal bleeding in children.

The purpose of this study was to assess the incidence and clinical significance of famotidine-associated thrombocytopenia in the trauma patient population. A retrospective cohort study was performe...Thrombocytopenia, if left untreated, increases the risk of rebleeding and hemodynamic instability, which may be devastating to patients suffering from UGIBs. ... recommended transfusing platelets to maintain a goal platelet count of >20,000 cells/uL and to switch pantoprazole to famotidine due to possible PPI-induced thrombocytopenia ...1 mar 2008 ... Patients receiving other drugs or with known bleeding in the upper part of the gastrointestinal tract, thrombocytopenia, or coagulopathy were ...Famotidine: learn about side effects, dosage, special precautions, and more on MedlinePlus Prescription famotidine is used to treat ulcers (sores on the lining of the stomach or small intestine); gastroesophageal reflux disease (GERD, a con...Background Chemoradiotherapy complications has always been of great concern to both clinicians and patients during the course of treatment. The purpose of the present study was to examine the effectiveness of oral famotidine on the reduction of hematologic complications of patients with esophageal and gastric cardia cancers undergoing radiotherapy. Methods A single-blind controlled trial was ...Significant: CNS effects including confusion, disorientation, hallucinations, delirium, agitation, lethargy and seizure (particularly in elderly and patients with renal impairment); may increase the risk of developing community-acquired pneumonia; may decrease the absorption of vitamin B 12. Blood and lymphatic system disorders: Rarely, …

Thrombocytopenia has not been found to be a significant side effect of PPI use. Topics: hospitals, community , thrombocytopenia , pantoprazole , proton pump inhibitors , adverse effects , purpura, thrombocytopenic, idiopathic , abdominal pain , diarrhea , did not receive therapy or drug , gastritisThrombocytopenia — Patients with critical or life-threatening bleeding and a low platelet count (<50,000/microL) should be transfused with platelets. Limited data suggest that proceeding with upper endoscopy in patients with thrombocytopenia is generally safe [ 28 ], though whether there is a lower limit below which endoscopy should be ...Thrombocytopenia is a condition that develops because your body does not have enough platelets. Platelets are cells that help your blood to clot. Your body may not be making enough platelets, or it may be destroying too many platelets. When platelets become low, your risk for bleeding increases. Severe bleeding may become life-threatening.Agreed. Typically the ICU team is reaching for the stars on why a patients platelet count is low and blame it on the Pepcid. Lots of reasons an ICU patient can be thrombocytopenic. Platelets are a bit of an acute phase reactant, infection, inflammation, fever, DIC, stress, HIT, malnutrition, thrombocytopenia of frequent phlebotomy, hemorrhage ...Mar 15, 2023 · Thrombocytopenia — Patients with critical or life-threatening bleeding and a low platelet count (<50,000/microL) should be transfused with platelets. Limited data suggest that proceeding with upper endoscopy in patients with thrombocytopenia is generally safe [ 28 ], though whether there is a lower limit below which endoscopy should be ...

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Famotidine undergoes minimal first-pass metabolism. Twenty-five to 30% of an oral dose was recovered in the urine as unchanged compound. The only metabolite identified in humans is the S-oxide. Excretion . Famotidine has an elimination half-life of 2.5 to 3.5 hours. Famotidine is eliminated by renal (65 to 70%) and metabolic (30 to 35%) routes.Reversible neutropenia and thrombocytopenia during famotidine treatment. Ann Pharmacother. 1994 Mar;28 (3):406-7. doi: 10.1177/106002809402800326.Generic Name Mirtazapine DrugBank Accession Number DB00370 Background. Mirtazapine is a tetracyclic piperazino-azepine antidepressant agent that was initially approved for the treatment of major depressive disorder (MDD) in the Netherlands in 1994. 13 This drug was first manufactured by Organon Inc., and received FDA approval in 1997 for the treatment of …Nov 16, 2008 · Worsening cytopenias, defined as development of new-onset anemia, thrombocytopenia, or leukopenia; or hemoglobin drop greater than 2 g/dl, or transfusion requirements. Bone marrow disorder, defined as morphologic, flow cytometric, and/or cytogenetic evidence of a primary bone marrow disorder. Stable disease, if none of the above conditions were ... See full list on emcrit.org

Thrombocytopenia, if left untreated, increases the risk of rebleeding and hemodynamic instability, which may be devastating to patients suffering from UGIBs. ... recommended transfusing platelets to maintain a goal platelet count of >20,000 cells/uL and to switch pantoprazole to famotidine due to possible PPI-induced thrombocytopenia ...Goals for anesthesia for cesarean delivery (CD) must include the comfort and safety of the parturient, and the well-being of the fetus and neonate. This topic will discuss the management of regional and general anesthesia for CD. Anesthesia for CD in patients with preeclampsia and neuraxial labor analgesia are reviewed separately.FAMOTIDINE TABLETS (famotidine tablets, USP) 20 mg and 40 mg Histamine H2 Receptor Antagonist ... anaphylaxis, angioedema, agitation, confusion, hallucinations, thrombocytopenia, leukopenia, neutropenia, and agranulocytosis. Interstitial pneumonia and Stevens Johnson syndrome/toxic epidermal necrolysis has been reported very rarely. In patientsFamotidine 20 mg, 20 tablets. Tablet, Famotidine 40 mg, 10 tablets. DESCRIPTION ... thrombocytopenia. – Hypersensitivity: anaphylaxis, angioedema, orbital or ...•for the treatment of thrombocytopenia in adult and pediatric patients 1 year and older with persistent or chronic immune thrombocytopenia (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. PROMACTA should be used only in patients with ITP whose degree of thrombocytopenia and clinicalVascular thrombosis is a common clinical feature of both essential thrombocythemia (ET) and heparin-induced thrombocytopenia (HIT). The development of HIT in a patient with ET is rare and underrecognized. We report the case of a 77-year-old woman with preexisting ET, who was admitted with acute coronary syndrome, and IV heparin was started.The authors reported that famotidine, received within 24 hours of hospital admission in 84 patients with COVID-19, was associated with reduced risk for death or intubation (adjusted HR 0.42, 95% CI 0.21–0.85) and also with reduced risk for death alone (HR 0.30, 95% CI 0.11–0.80). After baseline patient characteristics were balanced using ...B A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding. The patient receiving famotidine may experience hypotension as an adverse effect, not hypertension. Famotidine does not cause immunosuppression or urinary retention.PATHOGENESIS. The etiology of drug-induced immune thrombocytopenia is complex, at least six distinct pathologic mechanisms having been identified (Table 1).Heparin-induced thrombocytopenia (HIT) is technically the most common cause of drug-associated thrombocytopenia, but the drop in platelet levels in patients with HIT is rarely sufficient to provoke bleeding and thrombosis is the major ...

The incidence of thrombocytopenia in neurosurgical patients prescribed famotidine is unknown. Using hospital records of neurosurgery patients treated between July 2001 and July 2002, a retrospective cohort study was performed comparing platelet counts in patients treated with famotidine with a simil …

The incidence of thrombocytopenia in neurosurgical patients prescribed famotidine is unknown. Using hospital records of neurosurgery patients treated between July 2001 and July 2002, a retrospective cohort study was performed comparing platelet counts in patients treated with famotidine with a similar group of patients who were not prescribed an H2 antagonist.Thrombocytopenia increases the risk of rebleeding and hemodynamic instability, which may be devastating to patients suffering from UGIBs. Here, we present a case of thrombocytopenia that began after the introduction of pantoprazole in the setting of a UGIB. The thrombocytopenia resolved promptly after cessation of the medication.This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled.Mar 14, 2023 · Famotidine is a histamine-2 (H 2) receptor antagonist indicated (1): In adult and pediatric patients 40 kg and greater for the treatment of: • active duodenal ulcer (DU). • active gastric ulcer. • symptomatic nonerosive gastroesophageal reflux disease (GERD). • erosive esophagitis due to GERD, diagnosed by biopsy. ( 1) Drug-Induced Immune Thrombocytopenia Results of the Testing for Drug-Dependent Platelet-Reactive Antibodies by the BloodCenter of Wisconsin Data are from 1995-2018, provided with the permission of Daniel Bougie PhD, Janice McFarland MD, Brian Curtis, PhD and Richard Aster, MDThe phase IV clinical study analyzes which people take Famotidine and have Thrombocytopenia On the other hand, platelets are active players in pathogen clearance, leading to the possibility that a low platelet count and platelet function generic tetracycline cost alteration may first favour infection. 005) prolonged aPTT, PT, and TT.. When ...In patients who received famotidine, there was one occurrence of Clostridium difficile and 6 cases of electrolyte abnormalities. In patients who received a PPI, ...

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famotidine will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. ... Hematologic: Rare cases of agranulocytosis, pancytopenia, leukopenia, thrombocytopenia. Hypersensitivity: Anaphylaxis, angioedema, orbital or facial edema, urticaria, rash, conjunctival injection.Overview. Immune thrombocytopenia (ITP) is an illness that can lead to bruising and bleeding. Low levels of the cells that help blood clot, also known as platelets, most often cause the bleeding. Once known as idiopathic thrombocytopenic purpura, ITP can cause purple bruises. It also can cause tiny reddish-purple dots on the skin that look …pantoprazole to famotidine due to possible PPI-induced thrombocytopenia. Consequently, pantoprazole therapy was discontinued, oral famotidine 10 mg once daily was initiated, and 2 units of platelets were 2022 Phan et al. Cureus 14(2): e22326. DOI 10.7759/cureus.22326 2 of 6Drug-Induced Immune Thrombocytopenia Results of the Testing for Drug-Dependent Platelet-Reactive Antibodies by the BloodCenter of Wisconsin Data are from 1995-2018, provided with the permission of Daniel Bougie PhD, Janice McFarland MD, Brian Curtis, PhD and Richard Aster, MDThe incidence of thrombocytopenia in neurosurgical patients prescribed famotidine is unknown. Using hospital records of neurosurgery patients treated between July 2001 and July 2002, a retrospective cohort study was performed comparing platelet counts in patients treated with famotidine with a similar group of patients who were not prescribed ...Proton pump inhibitors (PPIs) are not widely recognized as a cause of drug-induced thrombocytopenia. Literature is mainly confined to case reports and has been insufficient to explore the possibility that this adverse event may be attributed to a class effect of PPI therapy. We present a case where platelet counts dropped from 177 (×10 (3) per ... Famotidine is an acid-suppressing agent that may be used to treat a wide range of gastric-acid-related disorders including gastric ulcers, heartburn, and GERD. A headache is the most common side... more. Prescription only. Pantoprazole is a proton pump inhibitor that decreases acid secretion in the stomach and may be given to relieve the ...Drug-induced thrombocytopenia (DITP), which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for hematologists. DITP typically appears suddenly, is often severe, and can cause major bleeding and death. 1 – 3 In many patients, the drug etiology is not initially recognized.Thrombocytopenia (throm-buh-sye-tuh-PEE-nee-uh) is when there aren't as many normal platelets in the blood as there should be. Platelets are tiny colorless cells in the blood that help the blood clot. Like all blood cells, platelets are made in the bone marrow (the spongy inner part of bones).The authors reported that famotidine, received within 24 hours of hospital admission in 84 patients with COVID-19, was associated with reduced risk for death or intubation (adjusted HR 0.42, 95% CI 0.21–0.85) and also with reduced risk for death alone (HR 0.30, 95% CI 0.11–0.80). After baseline patient characteristics were balanced using ...This topic review discusses drug-induced immune thrombocytopenia (DITP), in which the mechanism involves antibody-mediated platelet destruction caused by exposure to a drug that leads to isolated thrombocytopenia (without anemia or leukopenia). ….

Famotidine use and thrombocytopenia in the trauma patient The purpose of this study was to assess the incidence and clinical significance of famotidine-associated thrombocytopenia in the trauma patient population. Dec 10, 2017 · Proton pump inhibitors (PPIs) are the most effective and preferred class of drugs used to treat peptic ulcer disease, gastroesophageal reflux disease, and other diseases associated with increased production of gastric acid. PPIs in general have an excellent long-term safety profile and are well-tolerated. However, studies have shown some adverse reactions (e.g., osteoporosis,<i> Clostridium ... Thrombocytopenia is a rare adverse effect of famotidine therapy. 4-7. Few cases of famotidine-induced thrombocytopenia have been reported. Case reports have …Famotidine 20 mg, 20 tablets. Tablet, Famotidine 40 mg, 10 tablets. DESCRIPTION ... thrombocytopenia. – Hypersensitivity: anaphylaxis, angioedema, orbital or ...abnormalities, vitamin deficiencies, drug interactions, thrombocytopenia, etc) through ... **Famotidine oral solution should be used in patients with feeding ...In other ways it bears a very close resemblance to cimetidine; for example, headache and confusion with intravenous use are reported, as are thrombocytopenia and pancytopenia (SEDA-15, 395). The effects of famotidine 20 mg bd and omeprazole 20 mg/day for 8 weeks have been compared in the treatment of reflux esophagitis in a randomized trial in ... Famotidine tablets are a histamine-2 (H 2) receptor antagonist indicated ( 1 ): In adult and pediatric patients 40 kg and greater for the treatment of: • active duodenal ulcer (DU). • active gastric ulcer. • symptomatic nonerosive gastroesophageal reflux disease (GERD). • erosive esophagitis due to GERD, diagnosed by biopsy.Report signs of agranulocytosis and neutropenia (fever, sore throat, mucosal lesions, signs of infection, bruising), aplastic anemia (unusual fatigue, weakness), or thrombocytopenia (bruising, bleeding gums, nose bleeds).Thrombocytopenia means there are low levels of circulating platelets. A platelet count below 150,000/ µL is considered low. As such, a platelet count of 20,000/µL is consistent with a diagnosis of thrombocytopenia. A normal hemoglobin level is 12-17 g/dL depending on the sex of the patient.PEPCID to mean values of 5.0 and 6.4, respectively. When PEPCID was given after breakfast, the basal daytime interdigestive pH at 3 and 8 hours after 20 or 40 mg of PEPCID was raised to about 5. PEPCID had little or no effect on fasting or postprandial serum gastrin levels. Gastric emptying and exocrine pancreatic function were not affected by ... Famotidine thrombocytopenia, Thrombocytopenia due to H2-receptor antagonist is a rare but known phenomenon. By 2011, there were 29 cases of H2-receptor antagonist-induced thrombocytopenia. These cases were a mix of ranitidine, famotidine, and cimetidine-induced thrombocytopenia [23,24]. Majority of these 29 studies were, In these patients it is often difficult to assess accurately the cause of adverse effects such as thrombocytopenia. We evaluate the literature to better define thrombocytopenia related to H(2) antagonist administration and discuss mechanism, potential as a risk factor and case reports describing the severity and duration of thrombocytopenia., Fatty liver is found among people who take Famotidine, especially for people who are male, 60+ old. The phase IV clinical study analyzes which people take Famotidine and have Fatty liver. It is created by eHealthMe based on reports of 74,580 people who have side effects when taking Famotidine from the FDA, and is updated regularly., Proton pump inhibitors might induce leukopenia and thrombocytopenia. Neutrophil and platelet counts may go back to the normal range after proton pump inhibitors are stopped. Clinicians should be aware of this adverse effect even though it is very rare. Open in a separate window., Aug 23, 2023 · Famotidine starts to block stomach acid within 15 minutes to 1 hour of taking the medicine. The maximum effect usually occurs within 1 to 3 hours, and lasts for 10 to 12 hours after a single dose. It will also work to prevent heartburn if taken 10 to 60 minutes before a meal. Do not take more than 2 tablets in 24 hours. , Jun 6, 2022 · Diagnosis of drug-induced immune thrombocytopenia. Five clinical criteria have been proposed to help physicians to determine the diagnosis of DITP 1: 1) exposure to new drugs 5-10 days before onset of thrombocytopenia; 2) recovery from thrombocytopenia after discontinuing the candidate drug; 3) other drugs were continued or reintroduced after discontinuation of the candidate drug with a ... , Dec 1, 2011 · Intravenous famotidine therapy was the only variable found to be statistically significant after both univariate and multivariate analysis (P < 0.001 and P = 0.003, respectively). Thrombocytopenia became clinically significant in eight of 181 (4.4%) famotidine-treated patients or 11.1 per cent of those who developed thrombocytopenia. , PURPOSE: Patients on mechanical ventilation (MV) are at increased risk of gastrointestinal bleeding (GIB). Proton pump inhibitors (PPIs), though more potent and longer acting inhibitors of gastric acid production, are generally more expensive than Histamine-2-Receptor Antagonists (an H2RA). Data comparing the two as prophylactic agents to prevent gastrointestinal bleeding in critically ill ..., Seventy-two of 181 (39.8%) patients treated with famotidine developed thrombocytopenia compared with 23 of 126 (18.3%) untreated patients (P < 0.001). Patients who developed thrombocytopenia were ..., Famotidine binds more tightly to H 2 R (dissociation constant 17 nmol/L) than ranitidine (dissociation constant 200 nmol/L),16 but preincubation of platelets with 1.0 mmol/L famotidine had no significant effect on ranitidine-dependent binding of antibody to platelets at concentrations of ranitidine as low as 1.0 μmol/L ., Europe PMC is an archive of life sciences journal literature., In the 52 patients receiving cimetidine, ranitidine, or famotidine, thrombocytopenia and mental confu- sion were observed in only 2 patients, both of whom were in the cimetidine-treated group. The relatively new agent famotidine has not yet sustained the number of clinical trials that both cimetidine and ranitidine have., Thrombocytopenia is a medical condition characterized by a low platelet count in the blood. Normally, platelets are responsible for blood clotting, and a low platelet count can lead to bleeding, bruising, and other complications. Thrombocytopenia is said when platelet count falls below 150,000. Thrombocytopenia can be caused by diseases that ..., Seventy-two of 181 (39.8%) patients treated with famotidine developed thrombocytopenia compared with 23 of 126 (18.3%) untreated patients (P < 0.001). …, Patients admitted to the hospital are also given famotidine as stress ulcer prophylaxis, a rare cause of thrombocytopenia, usually seen in critically ill patients but can have numerous other reasons for thrombocytopenia . Our patient was not critically sick during her prior admission and had previous multiple exposures to famotidine without effect., thrombocytopenia / Delayed / Incidence not known impotence (erectile ... Famotidine/Heartburn Relief/Pepcid/Pepcid AC/Pepcid AC Maximum Strength/Zantac ..., The main adverse reactions to famotidine were diarrhea and increased total bilirubin [43]. Immunologic A 23-year-old man was given cefazodone 1 g and famotidine 20 mg intravenously before an operation for a hematocele [44 A]. Immediately after the injection of famotidine, he complained of dyspnea, developed seizure-like symptoms, and became ..., Hematologic: thrombocytopenia. Hypersensitivity: ... Famotidine Tablets USP, 40 mg are available as tan, round, unscored, film-coated tablets, debossed with “5729” on one side and “TEVA” on the other side, containing 40 mg famotidine, packaged in bottles of 100 (NDC 0172-5729-60) and 500 (NDC 0172-5729-70) tablets. ..., See full list on emcrit.org , Kansas Journal of Medicine 2015 Famotidine-Induced Thrombocytopenia 29 Drug Intell Clin Pharm 1989; 23(6):507-508. PMID: 2568035 5 Zimmermann AE, Katona BG, Hrehorovich VR. Probable famotidine-induced thrombocytopenia. 1991; DICP 25(6):678. PMID: 1877281. 6 Humphries JE. Thrombocytopenia associated with famotidine in a, , Probable Famotidine-Induced Thrombocytopenia Authors Ahmad Rahal University of Kansas Medical Center:KU School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214-3199, USA., Vascular thrombosis is a common clinical feature of both essential thrombocythemia (ET) and heparin-induced thrombocytopenia (HIT). The development of HIT in a patient with ET is rare and underrecognized. We report the case of a 77-year-old woman with preexisting ET, who was admitted with acute coronary syndrome, and IV heparin was started., The URL has moved here, Aug 23, 2023 · Famotidine starts to block stomach acid within 15 minutes to 1 hour of taking the medicine. The maximum effect usually occurs within 1 to 3 hours, and lasts for 10 to 12 hours after a single dose. It will also work to prevent heartburn if taken 10 to 60 minutes before a meal. Do not take more than 2 tablets in 24 hours. , Proton pump inhibitors (PPIs) are the most effective and preferred class of drugs used to treat peptic ulcer disease, gastroesophageal reflux disease, and other diseases associated with increased production of gastric acid. PPIs in general have an excellent long-term safety profile and are well-tolerated. However, studies have shown some adverse reactions (e.g., osteoporosis,<i> Clostridium ..., Abstract. H 2 antagonist ranitidine causing thrombocytopenia is a rare drug phenomenon. Here we present a case of 55 year old female of pustular psoriasis who presented with fever and vomiting. Patient. was started on roxithromycin, iv ondensetron, paracetamol and iv ranitidine. Complete blood count revealed neutrophilia with normal blood picture., Patients receiving other drugs or with known bleeding in the upper part of the gastrointestinal tract, thrombocytopenia, or coagulopathy were excluded. ... Conclusions Famotidine and pantoprazole are similarly effective for preventing bleeding in the upper part of the gastrointestinal tract in patients receiving mechanical ventilation., Thrombocytopenia has been reported rarely with IV and oral famotidine and may increase the risk of bleeding (Ref). Most patients who developed thrombocytopenia ..., Eight days prior to admission, famotidine therapy had been initiated. Famotidine was discontinued and granulocyte—macrophage colony stimulating factor was administered, with concomitant recovery of the granulocyte count and subsequent development of a …, Possible famotidine-induced thrombocytopenia. Possible famotidine-induced thrombocytopenia DICP. 1989 Jun;23(6):507-8. doi: 10.1177/106002808902300615. Authors J B Comer, J A Evans, A Kerns. PMID: 2568035 DOI: 10.1177/106002808902300615 No abstract available. Publication types ..., Probable Famotidine-Induced Thrombocytopenia Show all authors. Anthony E. Zimmermann, B.S.Pharm. Anthony E. Zimmermann. Senior Clinical Pharmacist Department of Pharmacy Harbor Hospital Center 3001 South Hanover Street Baltimore, Maryland 21230 See all …, Typically the ICU team is reaching for the stars on why a patients platelet count is low and blame it on the Pepcid. Lots of reasons an ICU patient can be thrombocytopenic. Platelets are a bit of an acute phase reactant, infection, inflammation, fever, DIC, stress, HIT, malnutrition, thrombocytopenia of frequent phlebotomy, hemorrhage ...