Tsuda Hiroyuki, Tsuji Takahiro, Tsuji Mayumi, Yamasaki Hiroshi
Department of Hematology and Oncology, Kumamoto City Hospital, Koto 1-1-60, East ward, Kumamoto, 862-8505, Japan.
Department of Environmental Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
Ann Hematol. 2017 Nov;96(11):1915-1920. doi: 10.1007/s00277-017-3095-6. Epub 2017 Aug 14.
Bleeding is the most important clinical outcome in patients with immune thrombocytopenia (ITP), and the goal of therapy in such cases is to treat or prevent bleeding. The frequency of and risk factors for bleeding events in ITP have only recently been identified in several large-scale studies. However, there is little published information about severe life-threatening bleeding in ITP. To clarify the clinical features of life-threatening bleeding in patients with primary ITP, we systematically reviewed the medical records of all ITP patients that were admitted to our hospital between January 1, 1992, and December 31, 2015. Of 169 consecutive inpatients with primary ITP, 8 suffered life-threatening bleeding (10 episodes: gastrointestinal, 4 cases; pulmonary, 1 case; and intracranial, 5 cases). All of these patients were ≥ 60 years of age and had platelet counts of < 20 × 10/L. The highest incidence of such bleeding was found among elderly patients in their 80s with platelet counts of < 5 × 10/L. Among the patients aged ≥ 60 years with platelet counts of < 20 × 10/L, the background data of the patients with and without life-threatening bleeding episodes were compared. It was shown that the patients in the bleeding group were older than those in the non-bleeding group (80.13 ± 2.31 vs. 73.39 ± 2.51 years, p = 0.0266). Hypertension, diabetes mellitus, anticoagulant use, ITP phase, and sex were not identified as strong risk factors for life-threatening bleeding. Combining age and the platelet count might be a useful way of identifying ITP patients that are at risk of life-threatening bleeding. Most intracranial hemorrhaging (4/5) was spontaneous and multifocal, suggesting that these might be characteristics of ITP-related bleeding in elderly patients.
出血是免疫性血小板减少症（ITP）患者最重要的临床结局，此类患者的治疗目标是治疗或预防出血。ITP出血事件的发生频率和危险因素直到最近才在几项大规模研究中得以确定。然而，关于ITP中严重的危及生命的出血的公开信息很少。为了阐明原发性ITP患者危及生命出血的临床特征，我们系统回顾了1992年1月1日至2015年12月31日期间我院收治的所有ITP患者的病历。在169例连续的原发性ITP住院患者中，8例发生了危及生命的出血（10次发作：胃肠道出血4例；肺部出血1例；颅内出血5例）。所有这些患者年龄均≥60岁，血小板计数<20×10⁹/L。此类出血的最高发生率见于80多岁、血小板计数<5×10⁹/L的老年患者。在年龄≥60岁、血小板计数<20×10⁹/L的患者中，比较了有和没有危及生命出血发作的患者的背景数据。结果显示，出血组患者比未出血组患者年龄更大（80.13±2.31岁 vs. 73.39±2.51岁，p = 0.0266）。高血压、糖尿病、抗凝剂使用、ITP分期和性别未被确定为危及生命出血的强危险因素。结合年龄和血小板计数可能是识别有危及生命出血风险的ITP患者的有用方法。大多数颅内出血（4/5）是自发性和多灶性的，这表明这些可能是老年患者ITP相关出血的特征。
