Definition of a critical bleed in patients with immune thrombocytopenia: Communication from the ISTH SSC Subcommittee on Platelet Immunology

Emily Sirotich; Gordon Guyatt; Caroline Gabe; Zhikang Ye; Carolyn E Beck; Vicky Breakey; Nichola Cooper; Adam Cuker; Jay Charness; Kerstin de Wit; Jennifer DiRaimo; Steven G Fein; Rachael F Grace; Ziauddin Hassan; Erin Jamula; Matthew Kang; Charles F Manski; Clare O'Connor; Menaka Pai; Dale Paynter; Stephen C Porter; Barbara Pruitt; Gail Strachan; Kathryn E Webert; Justin W Yan; John G Kelton; Tamam Bakchoul; Donald M Arnold

doi:10.1111/jth.15368

Definition of a critical bleed in patients with immune thrombocytopenia: Communication from the ISTH SSC Subcommittee on Platelet Immunology

J Thromb Haemost. 2021 Aug;19(8):2082-2088. doi: 10.1111/jth.15368.

Authors

Emily Sirotich^{1

2}, Gordon Guyatt², Caroline Gabe¹, Zhikang Ye², Carolyn E Beck³, Vicky Breakey⁴, Nichola Cooper⁵, Adam Cuker⁶, Jay Charness⁷, Kerstin de Wit^{8

9}, Jennifer DiRaimo¹⁰, Steven G Fein¹¹, Rachael F Grace¹², Ziauddin Hassan¹³, Erin Jamula¹, Matthew Kang^{9

14}, Charles F Manski¹⁵, Clare O'Connor¹⁶, Menaka Pai^{1

17

18}, Dale Paynter¹⁹, Stephen C Porter²⁰, Barbara Pruitt²¹, Gail Strachan²¹, Kathryn E Webert^{22

23}, Justin W Yan^{24

25}, John G Kelton²⁶, Tamam Bakchoul²⁷, Donald M Arnold¹

Affiliations

¹ Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
⁴ Division of Pediatric Hemaology/Oncology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁵ Department of Immunology and Inflammation, Department of Medicine, Imperial college, London, UK.
⁶ Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁷ Arvada, CO, USA.
⁸ Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.
⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹⁰ Platelet Disorder Support Association, Cleveland, OH, USA.
¹¹ Heme Onc Call, USA.
¹² Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA.
¹³ Department of Emergency Medicine, Dr FH Wigmore Regional Hosiptal, Saskatchewan Health Authority, Saskatoon, SK, Canada.
¹⁴ Department of Medicine, Joseph Brant Hospital, Burlington, ON, Canada.
¹⁵ Department of Economics and Institute for Policy Research, Northwestern University, Evanston, IL, USA.
¹⁶ Hamilton Health Sciences and McMaster School of Nursing, Hamilton, ON, Canada.
¹⁷ Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁸ Hamilton Regional Laboratory Medicine Program, Hamilton, ON, Canada.
¹⁹ Platelet Disorder Support Association (PDSA), Cleveland, OH, USA.
²⁰ Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
²¹ Platelet Disorder Support Association, Cincinnati, OH, USA.
²² Canadian Blood Services, Hamilton, ON, Canada.
²³ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
²⁴ Division of Emergency Medicine, Department of Medicine, Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada.
²⁵ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
²⁶ Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
²⁷ Institute for Clinical and Experimental Transfusion Medicine, University Hospital Tübingen, Tübingen, Germany.

PMID: 34327824
DOI: 10.1111/jth.15368

Abstract

Background: Immune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts and increased risk of bleeding. In preparation for an upcoming guideline, the ITP Emergency Management Guideline Panel, including clinical experts in hematology, emergency medicine, research methodology, and patient representatives, identified the need for a standardized definition of a critical ITP bleed. The goal of the definition was to distinguish critical bleeds from bleeds that may not require urgent treatment, typically in the context of severe thrombocytopenia.

Methods: The panel met in person and virtually to achieve consensus on the criteria for critical bleeding events among patients with ITP. Existing ITP bleeding scores and published definitions of major bleeds in patients receiving anticoagulation informed the definition of a critical ITP bleed. The Platelet Immunology Scientific Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis endorsed the definition.

Results: A critical ITP bleed was defined as: (a) a bleed in a critical anatomical site including intracranial, intraspinal, intraocular, retroperitoneal, pericardial, or intramuscular with compartment syndrome; or (2) an ongoing bleed that results in hemodynamic instability or respiratory compromise.

Conclusion: The definition of a critical ITP bleed was developed by the ITP Emergency Management Guideline Panel and endorsed by the Platelet Immunology SSC. It incorporates both anatomic and physiologic risk and pertains to patients with confirmed or suspected ITP who typically have severe thrombocytopenia (platelet count below 20 × 10⁹ /L).

Keywords: blood platelets; emergencies; hemorrhage; idiopathic; purpura; thrombocytopenic.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Communication
Hemorrhage / diagnosis
Humans
Purpura, Thrombocytopenic, Idiopathic* / diagnosis
Reference Standards
Thrombocytopenia* / diagnosis

Abstract

Publication types

MeSH terms

Grants and funding