Evaluation of Thrombocytopenia in Critically Ill Patients Receiving Continuous Renal Replacement Therapy.

BACKGROUND: Continuous renal replacement therapy (CRRT) may be associated with thrombocytopenia in critically ill patients. A confounding factor is concomitant use of unfractionated heparin (UFH) and suspicion for heparin-induced thrombocytopenia (HIT). OBJECTIVE: To determine the impact of CRRT on platelet count and development of thrombocytopenia. METHODS: Retrospective analyses evaluated the intrapatient change in platelet count following CRRT initiation. Critically ill adult patients who received CRRT for at least 48 hours were included. The primary outcome was intrapatient change in platelet count from CRRT initiation through the first 5 days of therapy. Secondary outcomes included thrombocytopenia incidence, identification of concomitant factors associated with thrombocytopenia, and frequency of HIT. RESULTS: 80 patients were included. Median platelet count at CRRT initiation (D0) was 128000/µL (81500-212500/µL), which was higher than those on subsequent post-CRRT days (D1: 104500/µL [63000-166750/µL]; D2: 88500/µL [53500-136750/µL]; D3: 91000/µL [49000-138000/µL]; D4: 93000/µL [46000-134000/µL]; and D5: 76000/µL [45500-151000/µL]; P < 0.05 for all). Twenty-five (35%) patients had thrombocytopenia on CRRT D0 compared with D2 (56.3%), D3 (58.7%), and D5 (59.1%); P < 0.05 for all. Controlling for potential confounders, Sequential Organ Failure Assessment score at the time of CRRT initiation was the only independent factor associated with thrombocytopenia. One (1.3%) patient had confirmed HIT. Conclusion and Relevance: This study is the first to demonstrate serial decreases in platelet count across multiple days after CRRT initiation. These data may provide additional insight to thrombocytopenia development in critically ill patients receiving heparin while on CRRT that is not associated with HIT.

Correlation of the Pharmacy Curriculum Outcomes Assessment and Selected Pre-pharmacy and Pharmacy Performance Variables.

Objective. To identify the correlation between the Pharmacy Curriculum Outcomes Assessment (PCOA) and pre-pharmacy and pharmacy performance variables. Methods. Four years of PCOA data (2012-2015) were analyzed for students taking the assessment in the third professional year (P3). Using the Pearson correlation coefficient, data was correlated to a series of performance variables: pre-pharmacy grade point average (GPA), pre-pharmacy science GPA (pre-pharmacy science courses only), Pharmacy College Admission Test (PCAT) composite score, P3 pre-advanced pharmacy practice experience (APPE) GPA and the North American Pharmacist Licensure Examination (NAPLEX). Scores that were correlated at r ≥ 0.30 were added to a multivariate linear regression model to compare their unique contributions. Results. There was a moderate correlation between PCOA and PCAT (r=0.60), P3 pre-APPE GPA (r=0.60) and the NAPLEX (r=0.64). The multivariate regression analysis explained 60% of the variance of the total PCOA score, with PCAT making the largest unique contribution. Conclusion. The PCOA was moderately to strongly correlated to the pre-APPE GPA, thus providing an acceptable assessment of student learning. The PCOA was also moderately to strongly correlated to the NAPLEX, making it a useful tool in predicting performance and identifying students in need of further remediation before the NAPLEX.