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Definition of a critical bleed in patients with immune thrombocytopenia: Communication from the ISTH SSC Subcommittee on Platelet Immunology
Author(s) -
Sirotich Emily,
Guyatt Gordon,
Gabe Caroline,
Ye Zhikang,
Beck Carolyn E,
Breakey Vicky,
Cooper Nichola,
Cuker Adam,
Charness Jay,
de Wit Kerstin,
DiRaimo Jennifer,
Fein Steven G.,
Grace Rachael F.,
Hassan Ziauddin,
Jamula Erin,
Kang Matthew,
Manski Charles F.,
O'Connor Clare,
Pai Menaka,
Paynter Dale,
Porter Stephen C.,
Pruitt Barbara,
Strachan Gail,
Webert Kathryn E.,
Yan Justin W.,
Kelton John G.,
Bakchoul Tamam,
Arnold Donald M.
Publication year - 2021
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.15368
Subject(s) - medicine , bleed , guideline , immune thrombocytopenia , context (archaeology) , intensive care medicine , hematology , surgery , platelet , pathology , paleontology , biology
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 × 10 9 /L).