Bleeding disorders

A common problem in the critically ill, this may be due to (i) large vessel bleeding—usually 'surgical' or following a procedure (e.g. chest drain, tracheostomy, accidental arterial puncture, removal of intravenous or intra-arterial catheter); peptic ulcer bleeding is now relatively uncommon due to improved attention to perfusion and nutrition; (ii) around vascular catheter sites or from intubated/instrumented lumens and orifices — usually related to severe multisystem illness or excess anticoagulant therapy, including thrombolytics; (iii) small vessel bleeding, e.g. skin petechiae, gastric erosions—usually related to anticoagulation or severe generalised illness including disseminated intravascular coagulation.

A falling platelet count is often an early sign of sepsis and critical illness. Recovery of the count usually coincides with overall patient recovery.

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