Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Jul 8;9(13):3238-3248.
doi: 10.1182/bloodadvances.2024015494.

Critical bleeding in adults and children with immune thrombocytopenia: a multicenter cohort study

Emily Sirotich  1   2 , Saifur R Chowdhury  1   2 , Dimpy Modi  1   3 , Gordon Guyatt  2   3   4 , Melanie St John  1 , Kerolos Eisa  1 , Adam Cuker  5   6 , Carolyn E Beck  7 , Rachael F Grace  8 , Justin W Yan  9 , Shuoyan Ning  1   3 , Charles T Quinn  10   11 , Amanda Pfeiffer  10 , Michele P Lambert  12   13 , Karen Panckeri  14 , Allyson Pishko  14 , Kristine VanAarsen  9 , Ahmed Slim  15 , Kathryn Carrier  16 , Rebecca Geer  10 , Abinaya Arulselvan  12 , Matthew Basara  12 , Brenna Cannon  12 , Ellis J Bloom  12 , Sam J King  12 , Daya Gill  1 , Laura M Venier  1 , Emily Xu  1 , Ishaq Siddiqui  1 , Bonnie Liu  1 , Timothy Mercier  8 , Taylah Buissereth  8 , Emily M Harris  8 , Enass H Raffa  17   18 , Joel Livingston  19 , Mahmudur Rahman Chowdhury  20 , Maryam Akbari-Moghaddam  1   21 , Dongyoung Kim  1 , Lehana Thabane  2   22 , Dena Zeraatkar  2   23 , Donald M Arnold  1   2   3
Affiliations
Multicenter Study

Critical bleeding in adults and children with immune thrombocytopenia: a multicenter cohort study

Emily Sirotich et al. Blood Adv. .

Abstract

Critical bleeding in patients with immune thrombocytopenia (ITP) is a life-threatening hematologic emergency. This study aimed 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 with a platelet count <20 × 109/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 critical bleeds (adults, n = 15 [median age, 68 years]; children, n = 13 [median age, 11 years]). Of patients with critical bleeds, 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 IV immunoglobulin (n = 8 [53.3%]), and for children, common interventions were IV immunoglobulin (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 (n = 4 [30.8%]). For both adults and children, the most common treatment combination was corticosteroids, IV immunoglobulin, 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 patients (32.1%) 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.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: A.C. reports personal fees from Synergy, Sanofi, Pfizer, MingSight, and UpToDate, outside the submitted work. R.F.G. reports research funding from Agios, Novartis, and Sobi; and had a consultancy role with Agios, Sanofi, and Sobi, outside the submitted work. M.P.L. reports personal fees from Novartis Dova, Principia, argenx, Rigel, Sobi, Sanofi, Janssen, and UpToDate; and research funding from Novartis Dova, Principia, argenx, Rigel, Sobi, Sanofi, and Janssen. A.P. served on an advisory board for Biomarin and received authorship royalties from UpToDate. D.M.A. reports research grants from Rigel; and personal fees from Rigel, Amgen, Medison, Daiichi Sankyo, Sobi, Principia, Chugai, Alpine, argenx, Sanofi, and UpToDate, outside the submitted work. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Recruitment of patients with ITP.
See this image and copyright information in PMC

References

    1. Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports. Am J Hematol. 2010;85(3):174–180. - PubMed
    1. Neunert C, Noroozi N, Norman G, et al. Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review. J Thromb Haemost. 2015;13(3):457–464. - PMC - PubMed
    1. Abrahamson PE, Hall SA, Feudjo-Tepie M, Mitrani-Gold FS, Logie J. The incidence of idiopathic thrombocytopenic purpura among adults: a population-based study and literature review. Eur J Haematol. 2009;83(2):83–89. - PubMed
    1. Schoonen WM, Kucera G, Coalson J, et al. Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database. Br J Haematol. 2009;145(2):235–244. - PubMed
    1. Yong M, Schoonen WM, Li L, et al. Epidemiology of paediatric immune thrombocytopenia in the General Practice Research Database. Br J Haematol. 2010;149(6):855–864. - PubMed

Publication types

Substances