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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 1572-1574
Is there any correlation between the severity of an injury and thrombocytosis in multiple trauma patients?


1 Department of Emergency Medicine, Jahrom University of Medical Science, Jahrom, Iran
2 Department of Emergency Medicine, Zabol University of Medical Sciences, Zabol, Iran
3 Department of Emergency Medicine, Jahrom University of Medical Science, Tehran, Iran

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Date of Web Publication11-Jan-2018
 

   Abstract 


Objective: Trauma is often the result of an overwhelming amount of stress that exceeds one's ability to cope or integrate the emotions involved with that experience. However, trauma differs between individuals according to their subjective experiences. People react to similar events differently. Platelets are acute-phase reactants. Patients and Methods: This is a retrospective study of all patients with trauma admitted to the trauma center. Atotal of 242patients with multiple traumas were identified through a prospective registry. The severity of illness was evaluated on the first day using the injury severity score(ISS). The platelet count was checked in all trauma patients at admission time, 24h later, and after 72h. Results: The 242patients with multiple traumas who were in the emergency department of Peymanieh Hospital showed that there was correlation between the severity of injury in multiple trauma patients and a change in the platelet count after 24h(P<0.05). The platelet count after 24h in minor and moderate ISS groups had decreased. However, in critical ISS group patients, the count increased after 24h. Conclusion: There was a correlation between the severity of the injury and thrombocytosis in multiple trauma patients.

Keywords: Injury severity score, multiple trauma, thrombocytosis

How to cite this article:
Akbari H, Jalali A, Abdollahi A, Hosseinpoor M, Dowlatkhah H. Is there any correlation between the severity of an injury and thrombocytosis in multiple trauma patients?. Ann Trop Med Public Health 2017;10:1572-4

How to cite this URL:
Akbari H, Jalali A, Abdollahi A, Hosseinpoor M, Dowlatkhah H. Is there any correlation between the severity of an injury and thrombocytosis in multiple trauma patients?. Ann Trop Med Public Health [serial online] 2017 [cited 2018 May 23];10:1572-4. Available from: http://www.atmph.org/text.asp?2017/10/6/1572/222674



   Introduction Top


Refractory thrombocytosis or secondary thrombocytosis is defined as an increase in platelet count above 450×10 after exposure to stress stimuli. The stress disorders are systemic infections, inflammatory conditions, bleeding, and trauma.

Recent investigations have suggested that responses to traumatic stressors also appear to have a psychological foundation that could result in disorders of immune function and blood cell count.[1] Rises in leukocyte, lymphocyte, and T cell counts, and changes in the cell-mediated immune system have been reported.[2],[3]

Trauma is often the result of an overwhelming amount of stress that exceeds one's ability to cope or integrate the emotions involved with that experience. However, trauma differs between individuals according to their subjective experiences. People react to similar events differently. Platelets are acute-phase reactants.

The purpose of this study was to determine a correlation between severity of trauma and thrombocytosis in multiple trauma patients.[4]


   Patients and Methods Top


This is a retrospective study of all patients with trauma admitted to the trauma center of Peymanieh Hospital at Jahrom between February 2014 and July 2016. Atotal of 242patients with multiple traumas were identified through a prospective registry. The severity of illness was evaluated on the first day using the injury severity score(ISS). This was based on the presence or absence of cardiac, respiratory, hepatic, renal, neurologic, and hematologic disorders and/or infections.[5] Other variables were recorded as well. These include age, sex, site of the major injury, and specific injury.

Patient-specific data were abstracted into an Excel worksheet. The data elements included age, gender, mechanism of injury, injury sustained and operative procedures, admission vitals(heart rate, systolic blood pressure, Glasgow coma score), laboratory values(serial platelet counts), ISS, and outcomes such as length of stay in hospital or Intensive Care Unit.[6]

The platelet count has been checked in all trauma patients at admission time, 24h later, and after 72h. Thrombocytosis was defined as a platelet count<450×10. We evaluated patients with serial platelet counts.

The inclusion criteria were all patients with multiple traumas who were admitted to Peymanieh Hospital's emergency department with each ISS.

The exclusion criteria were patients with multiple traumas who had underlying disorders that might affect the platelet count, such as any hematologic disorders.


   Results Top


Of the 242patients with multiple traumas who were at the emergency department in Peymanieh Hospital, 85% were men and 15% were women. The average age of the patients was 32.45±18.43years.

Here, 46.8% were admitted with 58.4% of them having surgery and about 82.7% getting a brain CT scan. About 54.7% of them had a critical ISS[Table1].
Table 1: Demographic characteristics in trauma patients

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The result of the t-test showed that in patients with a minor or moderate ISS, the platelet count decreased after 24h(P<0.05). However, in patients with a severe and critical ISS, the count elevated after 24h[Table2].
Table 2: Comparing the change in platelet counts separately for each injury severity score category

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The result of the ANOVA test showed correlation between the severity of the injury in multiple trauma patients and the change in the platelet count after 24h(P<0.05).

The platelet count after 24h in minor and moderate ISS groups had decreased, but in critical ISS group patients, it increased after 24h[Table3].
Table 3: Compare platelet change in the ISS category

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   Discussion Top


Reactive thrombocytosis is considered a normal response after inflammatory insults such as infection, surgery, or trauma.[7] Our examination found that thrombocytosis occurs in most patients with a critical ISS.

The majority of these patients developed delayed thrombocytosis. This delayed group was more severely injured and required a significantly greater number of surgical interventions.[6]


   Conclusion Top


In our study, thrombocytosis appeared to be a marker related to the outcome. Trauma patients who subsequently developed thrombocytosis had, on average, a higher predicted risk of death at admission.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sadr Mohammadi R, Mahdian M, Bidaki R, Mostafavi SA. Essential thrombocytosis following multiple psychic traumas. Emergency (Tehran) 2014;2:178-9.  Back to cited text no. 1
    
2.
Hohwü L, Li J, Olsen J, Sørensen TI, Obel C. Severe maternal stress exposure due to bereavement before, during and after pregnancy and risk of overweight and obesity in young adult men: A Danish national cohort study. PLoS One 2014;9:e97490.  Back to cited text no. 2
    
3.
Boscarino JA. Diseases among men 20 years after exposure to severe stress: Implications for clinical research and medical care. Psychosom Med 1997;59:605-14.  Back to cited text no. 3
[PUBMED]    
4.
Krishnan K, Nagalla S. Secondary Thrombocytosis. MedScape; 2016.  Back to cited text no. 4
    
5.
Valade N, Decailliot F, Re'bufat Y, Heurtematte Y, Duvaldestin P, Ste'phan F. Thrombocytosis after trauma: Incidence, aetiology, and clinical significance. Br J Anaesthesia 2005;94:18-23.  Back to cited text no. 5
    
6.
Salim A, Hadjizacharia P, DuBose J, Kobayashi L, Inaba K, ChanLS, et al. What is the significance of thrombocytosis in patients with trauma? J Trauma 2009;66:1349-54.  Back to cited text no. 6
[PUBMED]    
7.
Nijsten MW, ten Duis HJ, Zijlstra JG, Porte RJ, Zwaveling JH, PalingJC, et al. Blunted rise in platelet count in critically ill patients is associated with worse outcome. Crit Care Med 2000;28:3843-6.  Back to cited text no. 7
[PUBMED]    

Top
Correspondence Address:
Hamideh Akbari
Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_519_17

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    Tables

  [Table1], [Table2], [Table3]



 

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