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

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.