Bleeding is the most important clinical outcome in patients with immune thrombocytopenia (ITP), and the goal of therapy in such cases is to treat or prevent bleeding. The frequency of and risk factors for bleeding events in ITP have only recently been identified in several large-scale studies. However, there is little published information about severe life-threatening bleeding in ITP. To clarify the clinical features of life-threatening bleeding in patients with primary ITP, we systematically reviewed the medical records of all ITP patients that were admitted to our hospital between January 1, 1992, and December 31, 2015. Of 169 consecutive inpatients with primary ITP, 8 suffered life-threatening bleeding (10 episodes: gastrointestinal, 4 cases; pulmonary, 1 case; and intracranial, 5 cases). All of these patients were ≥ 60 years of age and had platelet counts of < 20 × 109/L. The highest incidence of such bleeding was found among elderly patients in their 80s with platelet counts of < 5 × 109/L. Among the patients aged ≥ 60 years with platelet counts of < 20 × 109/L, the background data of the patients with and without life-threatening bleeding episodes were compared. It was shown that the patients in the bleeding group were older than those in the non-bleeding group (80.13 ± 2.31 vs. 73.39 ± 2.51 years, p = 0.0266). Hypertension, diabetes mellitus, anticoagulant use, ITP phase, and sex were not identified as strong risk factors for life-threatening bleeding. Combining age and the platelet count might be a useful way of identifying ITP patients that are at risk of life-threatening bleeding. Most intracranial hemorrhaging (4/5) was spontaneous and multifocal, suggesting that these might be characteristics of ITP-related bleeding in elderly patients.
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Diz-Kucukkaya R, Lopez JA (2016) Thrombocytopenia. In: Kaushansky K, Lichtman PJT et al (eds) Williams Hematology, 9th edn. McGraw Hill, New York, pp 1993–2024
Portielje JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A (2001) Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 97:2549–2554
Frederiksen H, Maegbaek ML, Norgaard M (2014) Twenty-year mortality of adult patients with primary immune thrombocytopenia: a Danish population-based cohort study. Br J Haematol 166:260–267
Lacey JV, Penner JA (1977) Management of idiopathic thrombocytopenic purpura in adult. Sem Thromb Hemos 3:160–174
Nahirniak S, Slichter SJ, Tanael S et al (2015) Guidance on platelet transfusion for patients with hypoproliferative thrombocytopenia. Transfus Med Rev 29:3–13
Schattner E, Bussel J (1994) Mortality in immune thrombocytopenic purpura: report of seven cases and consideration of prognostic indicators. Am J Hematol 46:120–126
Neunert C, Noroozi N, Norman G et al (2015) Severe bleeding events in adults and children with primary immune thrombocythemia: a systemic review. J Thromb Hemos 12:457–464
Cohen YC, Djulbegovic B, Lubovitz MB (2000) The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 160:1630–1638
Kuhne T, Berchtold W, Michaels LA et al (2011) Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group. Haematologica 96:1831–1837
Neunert CE, Buchanan GR, Imbach P et al (2008) Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. Blood 112:4003–4008
Neylon AJ, Saunder PWG, Howard MR et al (2003) Clinical significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 122:966–974
Moulis G, Palmaro A, Montastruc JL et al (2014) Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood 124:3308–3315
Altomare I, Cetin K, Wetten S, Wasser JS (2016) Rate of bleeding-related episodes in adult patients with primary immune thrombocytopenia: a retrospective cohort study using a large administrative medical claim database in the US. Clin Epidemiol 8:231–239
Arnold DM (2015) Bleeding complications in immune thrombocytopenia. Hematology Am Soc Hematol Educ Program 2015:237–242
Rodeghiero F, Stasi R, Gernsheimer T et al (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 111:2386–2393
Rodeghiero F, Michel M, Gernsheimer T et al (2013) Standardization of bleeding assessment in immune thrombocytopenia: report from the International Working Group. Blood 121:2596–2606
Frederiksen H, Schmidt K (1999) The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood 94:909–913
Mahevas M, Michel M, Godeau B (2016) How we manage immune thrombocytopenia in elderly. Br J Haematol 173:844–856
Cortelazzo S, Finazzi G, Buelli M et al (1991) High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood 77:31–33
Michel M, Rauzy OB, Thoraval FR et al (2011) Characteristics and outcome of immune thrombocytopenia in elderly: results from a single center case-controlled study. Am J Hematol 86:980–984
Donato AJ, Morgan RG, Walker AE, Lesniewski LA (2015) Cellular and molecular biology of aging endothelial cells. J Mol Cell Cardiol 89(Pt B):122–135
Hanson SR, Slichter SJ (1985) Platelet kinetics in patients with bone marrow hypoplasia: evidence for a fixed platelet requirement. Blood 66:1105–1109
Psaila B, Petrovic A, Page LK et al (2009) Intracranial hemorrhage (ICH) in children with immune thrombocytopenia (ITP): study of 40 cases. Blood 114:4777–4783
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Tsuda, H., Tsuji, T., Tsuji, M. et al. Life-threatening bleeding episodes in primary immune thrombocytopenia: a single-center retrospective study of 169 inpatients. Ann Hematol 96, 1915–1920 (2017). https://doi.org/10.1007/s00277-017-3095-6
- Primary ITP