Critical bleeding in adults and children with immune thrombocytopenia: a multicenter cohort study

Critical bleeding in adults and children with immune thrombocytopenia: a multicenter cohort study

Abstract: Critical bleeding in patients with immune thrombocytopenia (ITP) is a life-threatening hematologic emergency. This study aimed to describe the frequency, management, and outcomes of critical bleeds among adults and children with ITP. We conducted a retrospective cohort study of patients wi...

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Main Authors: Emily Sirotich, Saifur R. Chowdhury, Dimpy Modi, Gordon Guyatt, Melanie St John, Kerolos Eisa, Adam Cuker, Carolyn E. Beck, Rachael F. Grace, Justin W. Yan, Shuoyan Ning, Charles T. Quinn, Amanda Pfeiffer, Michele P. Lambert, Karen Panckeri, Allyson Pishko, Kristine VanAarsen, Ahmed Slim, Kathryn Carrier, Rebecca Geer, Abinaya Arulselvan, Matthew Basara, Brenna Cannon, Ellis J. Bloom, Sam J. King, Daya Gill, Laura M. Venier, Emily Xu, Ishaq Siddiqui, Bonnie Liu, Timothy Mercier, Taylah Buissereth, Emily M. Harris, Enass H. Raffa, Joel Livingston, Mahmudur Rahman Chowdhury, Maryam Akbari-Moghaddam, Dongyoung Kim, Lehana Thabane, Dena Zeraatkar, Donald M. Arnold
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:Blood Advances
Online Access:http://www.sciencedirect.com/science/article/pii/S2473952925002198
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Summary:Abstract: Critical bleeding in patients with immune thrombocytopenia (ITP) is a life-threatening hematologic emergency. This study aimed to describe the frequency, management, and outcomes of critical bleeds among adults and children with ITP. We conducted a retrospective cohort study of patients with ITP who presented to the emergency room with a platelet count <20 × 109/L across 7 centers in the United States and Canada between 2010 and 2019. Of 1226 patients (n = 296 adults; n = 930 children), 28 (2.3%) had critical bleeds (adults, n = 15 [median age, 68 years]; children, n = 13 [median age, 11 years]). Of patients with critical bleeds, 12 adults (80.0%) and 6 children (46.2%) had intracranial hemorrhage (ICH). For adults, the common interventions used to treat critical bleeds were platelet transfusions (n = 11 [73.3%]), corticosteroids (n = 10 [66.7%]), and IV immunoglobulin (n = 8 [53.3%]), and for children, common interventions were IV immunoglobulin (n = 10 [76.9%]), corticosteroids (n = 8 [61.5%]), platelet transfusions (n = 8 [61.5%]), thrombopoietin receptor agonists (n = 4 [30.8%]), and antifibrinolytic agents (n = 4 [30.8%]). For both adults and children, the most common treatment combination was corticosteroids, IV immunoglobulin, and platelet transfusion (n = 6 [40.0%] vs n = 6 [46.2%]). The median time from presentation to first treatment was 6.9 hours for adults and 3.5 hours for children. Overall, 9 patients (32.1%) with critical ITP bleeds died, including 7 adults (46.7%) and 2 children (15.4%). Critical bleeding in patients with ITP was rare but frequently fatal, especially among older adults with ICH and when treatments were delayed.
ISSN:2473-9529

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