Trends and outcomes of new-onset thrombocytopenia in hospitalized patients: a secondary care center experience

Imran Nazir; Elham Hamed Alrubai; Nadeem Imran  Malik; Yasser Hefny Ahmed; Mohammed Al Mutairi; Saleh Al Alzahrani; Sara Al Alqethami; Haiqa Imran; Gamal T. Ebid; Khalid Khalil

doi:10.18203/2320-6012.ijrms20264150

Authors

Imran Nazir Department of Medicine. UMDC, Faisalabad, Pakistan
Elham Hamed Alrubai Department of Internal Medicine and Pulmonology, Security Forces Hospital. Makkah, KSA
Nadeem Imran Malik Department of IM/Pulmonology, ANMC, Lahore, Pakistan
Yasser Hefny Ahmed Department of Internal Medicine, Security Forces Hospital Makkah, KSA
Mohammed Al Mutairi Department of Internal Medicine, Security Forces Hospital Makkah, KSA
Saleh Al Alzahrani Department of Medicine, Security Forces Hospital Makkah, KSA
Sara Al Alqethami Department of Internal Medicine, Security Forces Hospital Makkah, KSA
Haiqa Imran Rahbar Medical College Lahore, Pakistan
Gamal T. Ebid Laboratory Department, NCI Cairo University, Egypt and Security Forces Hospital Makkah, KSA
Khalid Khalil Department of Internal Medicine and Hematology, Security Forces Hospital Makkah, KSA

DOI:

https://doi.org/10.18203/2320-6012.ijrms20264150

Keywords:

Thrombocytopenia, Sepsis, Platelets, In-hospital mortality

Abstract

Background: Thrombocytopenia is common among hospitalized patients and is associated with increased morbidity, prolonged hospitalization, and mortality. It may result from infection, sepsis, medications, disseminated intravascular coagulation (DIC), or other acute conditions. However, data on new-onset thrombocytopenia in secondary care hospitals in Saudi Arabia are limited. This study assessed its incidence, severity, etiology, and clinical outcomes in hospitalized adults.

Methods: This retrospective study was conducted at Security Forces Hospital, Makkah, Saudi Arabia, from January 2020 to December 2024. A total of 392 adult inpatients who developed new-onset thrombocytopenia (platelet count <150×10⁹/l) after admission were included using consecutive sampling. Patients with pre-existing thrombocytopenia, hematological malignancies, or recent chemotherapy were excluded. Demographic, clinical, laboratory, and outcome data were extracted from medical records. Thrombocytopenia severity and underlying etiologies were classified according to clinical and laboratory findings.

Results: Sepsis was the leading cause of new-onset thrombocytopenia (34.7%), followed by viral infections (19.6%), drug-induced thrombocytopenia (12.5%), and DIC (11.2%). Severe thrombocytopenia occurred in 26.5% of patients. ICU admission was required in 38.8%, while in-hospital mortality was 21.4%. Mortality was particularly higher among patients with sepsis-related and severe thrombocytopenia, highlighting the prognostic significance of both the underlying cause and degree of platelet reduction.

Conclusions: New-onset thrombocytopenia during hospitalization is associated with substantial morbidity and mortality. Early recognition, close monitoring, and prompt identification of underlying causes may improve outcomes, particularly in resource-limited secondary care settings.

References

Farooq M, Zafer MA, AlWazna M, Alrashah AS, Alkhamis S, Alsarem SK, et al. Clinical presentation and etiology of thrombocytopenia among patients at a tertiary care hospital in the Kingdom of Saudi Arabia. Cureus. 2026;18(4):e107700.

Pène F, Russell L, Aubron C. Thrombocytopenia in the intensive care unit: diagnosis and management. Ann Intensive Care. 2025;15(1):25.

Papakitsou I, Papazachariou A, Filippatos TD, Ioannou P. Incidence, risk factors, and outcomes of thrombocytopenia in older medical inpatients: a prospective cohort study. Hematol Rep. 2024;16(4):804-14.

Alqeeq BF, Ayyad M, Albandak M, Almadhoun WJ, Kullab M, Ghabayen AW, et al. The clinical significance of thrombocytopenia in sepsis and septic shock: a systematic review and meta-analysis. BMC Anesthesiol. 2025;25:327.

Cheng X, Ji M, Wang Y, Jiang X. Factors influencing thrombocytopenia in geriatric patients in the intensive care unit: a retrospective observational study. BMC Geriatr. 2025;25:870.

Gafter-Gvili A. Current approaches for the diagnosis and management of immune thrombocytopenia. Eur J Intern Med. 2023;108:18-24.

Raadsen M, Du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in virus infections. J Clin Med. 2021;10(4):877.

El Filaly H, Mabrouk M, Atifi F, Guessous F, Akarid K, Merhi Y, et al. Dissecting platelet's role in viral infection: a double-edged effector of the immune system. Int J Mol Sci. 2023;24(3):2009.

Mangalesh S, Dudani S, Malik A. Platelet indices and their kinetics predict mortality in patients of sepsis. Indian J Hematol Blood Transfus. 2021;37(4):600-8.

Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-3817.

Maouia A, Rebetz J, Kapur R, Semple JW. The immune nature of platelets revisited. Transfus Med Rev. 2020;34(4):209-20.

Belali TM. Bleeding disorders in Saudi Arabia, causes and prevalence: a review. Blood Coagul Fibrinolysis. 2024;35(3):67-72.

Alasmari S, Makkawi M, Alshehri A, Mansour AA, Shaikh A, Al Mohaya Y, et al. Assessment of the prevalence and coagulation profiles of individuals with coagulation factor deficiencies in the Asir Region, Saudi Arabia. Clin Lab. 2025;71(8).

Shaheen NA, Rehan H, Moghairi A, Gmati G, Damlaj M, Salama H, et al. Hematological indices in the adult Saudi population: reference intervals by gender, age, and region. Front Med (Lausanne). 2022;9:901937.

Russell L, Azoulay E, Anthon CT, Pène F, Akella P, Mabrouki A, et al. Platelet transfusion practice in the intensive care unit: the Nine-I international platelet transfusion survey. Ann Intensive Care. 2025;15(1):91.

Venkata C, Kashyap R, Farmer JC, Afessa B. Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J Intensive Care. 2013;1(1):9.

Santoshi RK, Patel R, Patel NS, Bansro V, Chhabra G. A comprehensive review of thrombocytopenia with a spotlight on intensive care patients. Cureus. 2022;14(8):e27718.