Critical bleeding in adults and children with immune thrombocytopenia: a multicenter cohort study. Journal Articles uri icon

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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.

authors

  • Sirotich, Emily
  • Chowdhury, Saifur R
  • Modi, Dimpy
  • Guyatt, Gordon
  • St John, Melanie
  • Eisa, Kerolos
  • Cuker, Adam
  • Beck, Carolyn E
  • Grace, Rachael F
  • Yan, Justin W
  • Ning, Shuoyan
  • Quinn, Charles T
  • Pfeiffer, Amanda
  • Lambert, Michele P
  • Panckeri, Karen
  • Pishko, Allyson
  • VanAarsen, Kristine
  • Slim, Ahmed
  • Carrier, Kathryn
  • Geer, Rebecca
  • Arulselvan, Abinaya
  • Basara, Matthew
  • Cannon, Brenna
  • Bloom, Ellis J
  • King, Sam J
  • Gill, Daya
  • Venier, Laura M
  • Xu, Emily
  • Siddiqui, Ishaq
  • Liu, Bonnie
  • Mercier, Timothy
  • Buissereth, Taylah
  • Harris, Emily M
  • Raffa, Enass H
  • Livingston, Joel
  • Chowdhury, Mahmudur Rahman
  • Akbari-Moghaddam, Maryam
  • Kim, Dongyoung
  • Thabane, Lehana
  • Zeraatkar, Dena
  • Arnold, Donald

publication date

  • July 8, 2025