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

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.

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Publication Details

Journal
Blood Advances
Published
2025-04-09
DOI
https://doi.org/10.1182/bloodadvances.2024015494
Citations
2
Primary Topic
Platelet Disorders and Treatments
Type
article
Field-Weighted Citation Impact
3.54

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article

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

Abinaya Arulselvan, Mahmudur Rahman Chowdhury, Donald M. Arnold, Amanda Pfeiffer et al.
2 citations
Blood Advances
Platelet Disorders and Treatments
3.54
article

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

Abinaya Arulselvan, Mahmudur Rahman Chowdhury, Donald M. Arnold, Amanda Pfeiffer, Dimpy Modi, Enass H. Raffa, Karen Panckeri, Laura M. Venier, Rachael F. Grace, Lehana Thabane, Maryam Akbari‐Moghaddam, Kristine Van Aarsen, Gordon Guyatt, Bonnie Liu, Michele P. Lambert, Justin W. Yan, Emily Harris, Emily Sirotich, Matthew Basara, Saifur Rahman Chowdhury, Melanie St John, Joel Livingston, Rebecca Geer, Taylah Buissereth, A. O. Slim, Brenna Cannon, Allyson M. Pishko, Emily Xu, Carolyn E Beck, Adam C. Cuker, Toine Mercier, Shuoyan Ning, Ellis Bloom, Kathryn Carrier, Kerolos Eisa, Dong‐Young Kim, Ishaq Siddiqui, Daya Gill, Dena Zeraatkar, Stephen J. King
article en
2 citations

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.

Blood AdvancesVol. 9(13)
Western University (CA), Cincinnati Children's Hospital Medical Center (US), Boston Children's Hospital (US), Children's Hospital of Philadelphia (US), University of Alberta (CA), North South University (BD), King Abdulaziz University (SA), University of Toronto (CA), Hospital of the University of Pennsylvania (US), London Health Sciences Centre (CA), King Faisal Specialist Hospital & Research Centre (SA), Hospital for Sick Children (CA), Boston Children's Museum (US), St Joseph's Health Care (CA), Stollery Children's Hospital (CA), Impact (CA), Dana-Farber/Boston Children's Cancer and Blood Disorders Center (US), St. Joseph’s Healthcare Hamilton (CA), University of Pennsylvania (US), Fafo Foundation (NO), University of Cincinnati Medical Center (US), McMaster University (CA)
Pfizer, Sanofi, Australian Government, Agios Pharmaceuticals, Canadian Blood Services, Einstein Stiftung Berlin, Swedish Orphan Biovitrum, Health Canada, Canadian Institutes of Health Research
Good health and well-being
Openalex Percentile: Top 8%
Platelet Disorders and Treatments
3.54
DOIOpen Access PDFOpenAlex
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