Sepsis is potentially life threatening organ dysfunction due to an extreme immune response to infection. Thrombocytopenia is when a person’s platelet count is extremely low. In some cases, sepsis can cause thrombocytopenia.

According to data from 2009–2014, sepsis is responsible for roughly 15.6% of hospital mortality. More recently, the Centers for Disease and Control Prevention (CDC) have reported that around 1 in 3 people who die in hospital had sepsis during that hospitalization.

This article reviews the connection between sepsis and thrombocytopenia. It also explores their symptoms, treatment, and when to contact a doctor.

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Sepsis occurs when an infection triggers a chain reaction in the body that leads to an extreme immune response. Without prompt treatment, it can cause tissue damage and organ failure. This can be fatal.

Thrombocytopenia is a condition where the amount of platelets in the blood is too low. Platelets help the blood bind together, or clot, and play a critical role in the immune response.

A person may inherit the condition at birth due to genetics or acquire it, which means they develop it later in life. Sepsis is one possible cause of acquired thrombocytopenia.

Platelet counts

The typical platelet count in adults is 150,000–450,000 per microliter (μL) of blood. A person with thrombocytopenia has a platelet count of fewer than 150,000 platelets per μL.

Thrombocytopenia is a relatively common occurrence in people with sepsis, occurring in around 5–20% of cases. It is associated with a less positive outlook, including a higher mortality rate and increased time in intensive care units for people with both conditions.

Platelet counts are also part of the Sepsis-related Organ Failure Assessment (SOFA) score. Doctors use SOFA scores to assess the severity of organ dysfunction in people who are critically ill.

The inclusion of platelet counts in SOFA scores may be due to the increased risk of mortality associated with thrombocytopenia and because the condition may indicate severe sepsis.

Septic shock

Septic shock develops when sepsis leads to thrombocytopenia and low blood pressure levels that are life threatening. Mechanisms involved in septic shock may include:

  • endothelial dysfunction, a type of nonobstructive coronary artery disease where the large blood vessels on the heart’s surface narrow instead of widen
  • coagulopathy, a blood disorder that impairs the body’s ability to make blood clots
  • altered thrombopoiesis, which are irregularities in how the body makes platelets
  • hemodilution, a procedure healthcare professionals use to help maintain a proper blood volume without a transfusion

Other possible causes

Other causes of thrombocytopenia in sepsis may include:

PTCP typically results from laboratory collection errors following contact with ethylenediaminetetraacetic acid, a coating in tubes for blood tests. It can cause platelets to clump together, potentially resulting in false low platelet counts.

A person with thrombocytopenia may not show any signs or symptoms. If symptoms do occur, they may include:

  • petechiae, which are small, flat red spots under the skin that occur due to blood leaking from blood vessels
  • purpura, which is bleeding under the skin that can cause purple, red, or brownish-yellow spots
  • blood in the urine or stool
  • prolonged bleeding, even from a small wound
  • nosebleeds or bleeding from the gums
  • heavy menstrual bleeding

Sepsis can cause additional symptoms to appear. These may include:

Healthcare professionals will aim to help increase a person’s platelet count and treat sepsis. Treatments for thrombocytopenia may include:

  • corticosteroids
  • medications such as eltrombopag and romiplostim, which help the body make more platelets
  • blood or platelet transfusions
  • splenectomy, which involves surgical removal of the spleen

Sepsis-related treatments typically involve the rapid administration of medications such as antibiotics to help fight infection and maintain blood flow to the organs. A doctor may recommend surgical removal of damaged tissue in some cases.

A person should seek medical attention immediately by calling 911 if they show signs of sepsis, such as:

  • confusion
  • extreme pain
  • shortness of breath

People with a higher risk of developing sepsis include:

It is also best to contact a healthcare professional as soon as possible about any symptoms of thrombocytopenia.

In some cases, sepsis may cause thrombocytopenia. Additionally, research suggests thrombocytopenia may worsen the severity and mortality rate of sepsis. Several factors related to sepsis may cause thrombocytopenia to occur.

Doctors aim to treat thrombocytopenia by increasing a person’s platelet count with medications, blood transfusions, or surgery. They typically treat sepsis by administering medications, such as antibiotics, to help fight the infection that caused it. They also try to maintain blood flow to the organs.

A person should call 911 immediately if they develop any signs or symptoms of sepsis, such as confusion or extreme pain.