https://orcid.org/0000-0003-4361-0792
Key Points
Though rare, critical ITP bleeding was fatal in 47% adults and 15% children, with higher mortality in older patients and delayed treatment.
The combination of corticosteroids, IVIG, and platelet transfusion was the most common treatment for critical ITP bleeding
Critical bleeding in patients with immune thrombocytopenia (ITP) is a life-threatening hematological emergency. The objective of this study was 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 (ER) with a platelet count <20 x109/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 a critical bleed (n=15 adults, median age 68 years; n=13 children, median age 11 years). Of patients with a critical bleed, 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 intravenous immune globulin (IVIG) (n=8; 53.3%); and for children, common interventions were IVIG (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 (tranexamic acid or aminocaproic acid, n=4; 30.8%). For both adults and children, the most common treatment combination was corticosteroids, IVIG, 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 (32.1%) patients 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.
