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Bleeding risk assessment in immune thrombocytopenia

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Abstract

The bleeding risk in immune thrombocytopenia (ITP) is related not only to low platelet count but also to the presence of platelet dysfunction. However, diagnosing a concomitant platelet dysfunction is challenging as most of the available platelet function assays (PFAs) require a platelet count of greater than 100,000/μL. Sonoclot coagulation and platelet function analyzer works on the principle of viscoelastometry, and results remain unaffected by the platelet counts. To assess the platelet function in adult acute ITP patients with the help of sonoclot coagulation and platelet function analyzer and correlate it with the risk of bleeding. Newly diagnosed acute ITP patients with a platelet count less than 20,000/μL were divided into two groups based on WHO bleeding grade: ITP non-bleeder (ITP-NB) group (WHO bleeding grade ≤1) and ITP bleeder (ITP-B) group (WHO bleeding grade ≥2). Platelet function was assessed by sonoclot in both groups. The patients without significant bleeding (ITP-NB) were followed up monthly for six months with the assessment of platelet function during each contact. Eighty patients (30 ITP-B and 50 ITP-NB) were prospectively included in this study. The median age of patients in the two groups was 37 years and 30 years, respectively. The female-to-male ratio was 4:1 and 1:1 in ITP-B and ITP-NB groups. The median platelet count in ITP-B and ITP-NB was 12000/μL (range 1000–19000/μL) and 8000/μL (range 1000–19000/μL), respectively. Mean platelet functions by sonoclot in both groups were lower than the normal cut-off (>1.6). However, the mean platelet function in the ITP-B group (0.2 + 0.17) was significantly lower than the ITP-NB group (1.2 ± 0.52) (p = 0.01). During the follow-up period of 6 months, patients in ITP-NB with a normal platelet function (>1.6) on sonoclot had lesser episodes (one episode) of clinically significant bleeding than patients with a low platelet function (4 episodes). Patients with acute severe thrombocytopenia and bleeding phenotype have a greater abnormality on platelet function by sonoclot than patients with non-bleeding phenotype. This information may help in taking therapeutic decisions in patients with acute ITP.

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Acknowledgements

We thank Mrs. Lalita for her untiring support. We also thank Mrs. Kusum for her help in data analysis. We thank all our patients for their unconditional support.

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Authors and Affiliations

  1. Department of Clinical Hematology and Medical Oncology, Post-Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Kundan Mishra, Aditya Jandial, Rajeev Sandal, Ashok Meshram, Deepesh Lad, Gaurav Prakash, Alka Khadwal, Subhash Varma & Pankaj Malhotra

  2. Department of Clinical Hematology, Army Hospital (Research and Referral), New Delhi, 110010, India

    Kundan Mishra & Rajan Kapoor

  3. Regional Cancer Centre, Indira Gandhi Medical College, Shimla, 171001, India

    Rajeev Sandal

  4. Department of Hematology, Post-Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Jasmina Ahluwalia & Neelam Varma

  5. Department of Hepatology, Post-Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    RK Dhiman

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  1. Kundan Mishra
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Contributions

K Mishra, A Jandial, D Lad, G Prakash, A Khadwal, R Kapoor, S Varma, and P Malhotra designed the study. K Mishra, A Jandial, R Sandal, and A Meshram performed the research. RK Dhiman, J Ahluwalia, Neelam Varma, and P Malhotra contributed essential reagents. K Mishra, A Jandial, D Lad, R Kapoor, and P Malhotra analyzed the data. K Mishra, A Jandial, and R Sandal wrote the paper. The manuscript was critically reviewed by all the authors. The final manuscript was vetted by all authors prior to submission.

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Correspondence to Kundan Mishra.

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Supplementary Information

ESM 1

Figure S1: Bar charts showing presenting complaints of patients in the ITP-NB group and ITP-B group.

ESM 2

Figure S2: Flow diagram of ITP patients who were followed up during the therapy.

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Mishra, K., Jandial, A., Sandal, R. et al. Bleeding risk assessment in immune thrombocytopenia. Ann Hematol 102, 3007–3014 (2023). https://doi.org/10.1007/s00277-023-05466-1

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