Risk factors for skin, mucosal, and organ bleeding in adults with primary ITP: a nationwide study in Japan.
Journal
Blood advances
ISSN: 2473-9537
Titre abrégé: Blood Adv
Pays: United States
ID NLM: 101698425
Informations de publication
Date de publication:
28 04 2020
28 04 2020
Historique:
received:
06
01
2020
accepted:
23
03
2020
entrez:
23
4
2020
pubmed:
23
4
2020
medline:
15
5
2021
Statut:
ppublish
Résumé
Bleeding manifestations in primary immune thrombocytopenia (ITP) range from skin petechiae to life-threatening intracranial hemorrhage (ICH). However, the relation between these various bleeding manifestations and the platelet count in ITP remains poorly characterized. Using a nationwide database of patients with ITP during the years 2005 to 2014 (10 years) in Japan, we analyzed 19 415 adult patients newly diagnosed with ITP, including 222 with ICH. The frequency of skin purpura was 64.8%, and this increased linearly with thrombocytopenia without a specific platelet count threshold. In contrast, mucosal bleeding (epistaxis and gingival bleeding) and organ bleeding (melena, hematuria, and ICH) increased exponentially with thrombocytopenia at a platelet count threshold of 10 to 15 × 109/L. Age showed a much weaker correlation than platelet count with skin and mucosal bleeding. However, the incidence of organ bleeding increased exponentially above 60 years of age. Multivariate analysis showed that the presence of mucosal bleeding was a risk factor for occurrence of melena and hematuria but not for ICH. The frequency of ICH was 1.1% and risk factors for ICH were age ≥60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 2.13-4.47; P < .001), platelet count <10 × 109/L (OR, 2.96; 95% CI, 2.11-4.15; P < .001), and the presence of hematuria (OR, 1.56; 95% CI, 1.04-2.35; P = .033). The relation between ICH and platelet count varied with age. This large-scale analysis of risk factors for bleeding in ITP has revealed distinct characteristics of skin, mucosal, and organ bleeding in adult patients with newly diagnosed ITP, thus indicating those who are at a high risk of severe organ bleeding.
Identifiants
pubmed: 32320469
pii: S2473-9529(20)31355-0
doi: 10.1182/bloodadvances.2020001446
pmc: PMC7189281
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1648-1655Informations de copyright
© 2020 by The American Society of Hematology.
Références
Hematology Am Soc Hematol Educ Program. 2015;2015:237-42
pubmed: 26637728
Blood. 2013 Apr 4;121(14):2596-606
pubmed: 23361904
J Med Assoc Thai. 2016 Jan;99(1):15-24
pubmed: 27455820
Am J Hematol. 2016 Dec;91(12):E499-E501
pubmed: 27528011
J Pediatr. 2002 Nov;141(5):683-8
pubmed: 12410198
Blood. 1991 Jan 1;77(1):31-3
pubmed: 1984800
Blood. 2011 Mar 31;117(13):3514-20
pubmed: 21263148
Blood. 2009 Nov 26;114(23):4777-83
pubmed: 19767509
Br J Haematol. 2007 Jul;138(2):245-8
pubmed: 17542983
Turk J Haematol. 2015 Jun;32(2):158-62
pubmed: 26316484
Semin Hematol. 2013 Jan;50 Suppl 1:S55-7
pubmed: 23664518
Int J Hematol. 2011 Mar;93(3):329-335
pubmed: 21347644
Ann Hematol. 2013 Jan;92(1):79-87
pubmed: 22956151
Am J Hematol. 1995 Apr;48(4):244-50
pubmed: 7717373
Arch Intern Med. 2000 Jun 12;160(11):1630-8
pubmed: 10847256
Cancer. 1981 Jan 1;47(1):207-14
pubmed: 7459811
J Thromb Haemost. 2015 Mar;13(3):457-64
pubmed: 25495497
J Pediatr Hematol Oncol. 2015 Apr;37(3):e158-61
pubmed: 25493457
Br J Haematol. 2003 Sep;122(6):966-74
pubmed: 12956768
Ann Hematol. 2017 Nov;96(11):1915-1920
pubmed: 28808759
Br J Haematol. 2014 Jul;166(2):260-7
pubmed: 24690142
Br J Haematol. 2009 Apr;145(2):235-44
pubmed: 19245432
Blood. 2014 Nov 20;124(22):3308-15
pubmed: 25305203
Blood Adv. 2019 Nov 26;3(22):3780-3817
pubmed: 31770441
J Thromb Haemost. 2018 Sep;16(9):1830-1842
pubmed: 29978544
Blood Adv. 2020 Jan 28;4(2):252
pubmed: 31945156