Acute bleeding and thrombocytopenia after bone marrow transplantation

S. Nevo, C. Enger, E. Hartley, M. E. Borinsky, V. Swan, A. K. Fuller, H. G. Braine, T. S. Kickler, J. N. George, G. B. Vogelsang

Research output: Contribution to journalArticle

Abstract

The relationship between hemorrhage and low platelet count was first established in patients with acute leukemia, and has been widely applied to thrombocytopenic patients, including BMT patients. Yet, the role of thrombocytopenia in bleeding post BMT has not been systematically studied. We evaluated the risk of bleeding and outcome associated with thrombocytopenia in BMT patients who had prophylactic platelet transfusions at a trigger of 20 × 109/1. Thrombocytopenia was investigated in 321 patients with moderate or severe bleeding (BLD), and in a matched comparison group of 287 patients who did not bleed (NBLD). Profound thrombocytopenia (≤10 × 109/l) was found in 8.6% of the BLD patients during the week before the bleeding onset, significantly more frequent than in NBLD patients (2.1% to 4%, P < 0.02), during weeks 2 to 6 post BMT (the period when 75% of the bleeding initiated). On the first day of bleeding, platelet counts ≤10 × 109/1 were found in 13.5%, 11-20 × 109/1 in 20.4%, and >20 × 109/1 in 66.1% of all episodes. Overall survival in BLD patients was not associated with the severity of thrombocytopenia before bleeding onset. Severity of thrombocytopenia was significantly associated with reduced survival in NBLD patients. We concluded that bleeding post BMT was significantly associated with thrombocytopenia, but the attributable risk of bleeding from profound thrombocytopenia was not large. Thrombocytopenia may be an important clinical sign in NBLD patients, and should be further explored in relation to acute toxicities other than bleeding.

Original languageEnglish (US)
Pages (from-to)65-72
Number of pages8
JournalBone marrow transplantation
Volume27
Issue number1
DOIs
StatePublished - 2001

Keywords

  • Bleeding
  • Bone marrow transplantation
  • Survival
  • Thrombocytopenia

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Nevo, S., Enger, C., Hartley, E., Borinsky, M. E., Swan, V., Fuller, A. K., Braine, H. G., Kickler, T. S., George, J. N., & Vogelsang, G. B. (2001). Acute bleeding and thrombocytopenia after bone marrow transplantation. Bone marrow transplantation, 27(1), 65-72. https://doi.org/10.1038/sj.bmt.1702717