Factors influencing bleeding severity in adult patients with primary immune thrombocytopenia

Objective Immune thrombocytopenia (ITP) is characterized by low platelet counts and associated with an increased bleeding risk. Still, bleeding severity in ITP patients differs individually and is not only determined by the platelet count.

We investigated bleeding severity and bleeding manifestations in a cohort of adult patients with primary ITP.

Material and Methods Patients with primary ITP were included in two haematological centers after written informed consent (EC 1843/2016). Bleeding severity was assessed with the ISTH ITP BAT (BS).1

Results Eighty-four patients (66.7% female) were included in the study (Table 1). The median BS [IQR] was 1 [0-3], with the highest score in the category skin. The most common bleeding manifestations were petechiae (26.8%), bleeding from small wounds (25.6%), and menorrhagia in women (25.9% of women). The median BS [IQR] was higher in patients with a platelet count ≤50x109 versus those with >50x109 (2 [1-7] and 1 [0-2]), in both, the categories skin (1 [0-3] and 0 [0-1]) and mucosal bleeding (1 [0-2] and 0 [0-1]). There was no difference in the BS according to sex, blood group O, chronic ITP, splenectomy status, or current ITP treatment. Of note, patients with bleeding symptoms at ITP onset had a higher BS compared to those without (2 [0-5] and 0 [0-1]). In a multivariable linear regression analysis, duration of disease (ß 0.009, 95%CI 0.001-0.016), and the immature platelet fraction (IPF, ß 0.185, 95%CI 0.043-0.327) were independent predictors of the BS, whereas the platelet count, sex, age, BMI and blood group O, and sP-selectin were not associated with bleeding severity in our cohort of primary ITP patients.

Conclusion Bleeding severity in our cohort of ITP patients was generally low and predicted by IPF and the disease duration of ITP. This might indicate that ITP caused by high platelet destruction is more prone to bleeding.

Tab 1. Paients' clinical and laboratory characteristics.

Publication History

Article published online:
18 June 2021