Feasibility and usefulness of self‐assessment of bleeding in patients with haematological malignancies, and the association between platelet count and bleeding

Stanworth, Simon; Dyer, Claire; Casbard, Angela; Murphy, Michael

doi:10.1111/j.1423-0410.2006.00785.x

Cited by 22 publications

(23 citation statements)

References 25 publications

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“…There is 86% agreement between bleeding data collected by self-assessment and by clinical examination. 21 In conclusion, this study demonstrated that severe hemorrhage is rare but can occur anywhere and at any time during the course of ITP. The majority of Chinese children with ITP should be observed without specific therapy.…”

Section: Discussionmentioning

confidence: 90%

Severe Hemorrhage in Chinese Children With Immune Thrombocytopenia

Zhou

Zhang

et al. 2015

Journal of Pediatric Hematology/Oncology

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To better understand the clinical features, therapy, and clinical outcome of Chinese patients with immune thrombocytopenia (ITP) who suffered severe hemorrhage, we retrospectively analyzed 663 children with ITP diagnosed in our hospital during the last 10 years. Of the total 663 patients enrolled in our study, 520 were eligible for bleeding severity assessment, of which 20 children (3.8%) had severe bleeding, including intracranial hemorrhage (ICH) (n = 9), gastrointestinal hemorrhage (n = 6), massive epistaxis (n = 3), urinary tract hemorrhage (n = 1), and pulmonary hemorrhage (n = 1). The age at diagnosis of severe hemorrhage ranged from 47 days to 14 years. Thirteen patients were newly diagnosed with ITP, 3 had persistent ITP, and 4 had chronic ITP. The latency between the onset of ITP and severe bleeding ranged from 6 hours to 10 years. The median platelet count at the time of severe hemorrhage was 6.5 × 10/L (range, 0 to 32 × 10/L). Most patients with severe hemorrhage were treated with intravenous immunoglobulin (90%), corticosteroids (65%), or both (60%). Two patients (10%) died because of ICH and pulmonary hemorrhage, respectively. Four patients (20%) recovered from thrombocytopenia. Our observation showed that severe hemorrhage is rare but can occur anywhere and at any time during the course of ITP. The majority of children with ITP in China should be observed rather than treated.

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Section: Discussionmentioning

confidence: 90%

Severe Hemorrhage in Chinese Children With Immune Thrombocytopenia

Zhou

Zhang

et al. 2015

Journal of Pediatric Hematology/Oncology

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“…Grade 1 bleeding is regarded as not clinically significant since it does not require intervention; however, it does inconvenience the patient and may be a forerunner of more severe bleeding [27]. Grade 2 bleeding is deemed to be clinically significant, but it is hard to distinguish from grade 1 bleeding even when trained and blinded assessors are used [28–30].…”

Section: Methodsmentioning

confidence: 99%

“…To some extent, any outcome measure based on the frequency and description of bleeding events requires a subjective assessment by the trialists. This inherently subjective component in the ascertainment of the outcome measure makes systematic recording and standardization of bleeding complications difficult [28–30, 33]. Even in RCTs, there is potential for bias if clinicians are making subjective decisions about the severity of bleeding complications and the need to transfuse platelets and/or RBCs.…”

Section: Methodsmentioning

confidence: 99%

“…Even in RCTs, there is potential for bias if clinicians are making subjective decisions about the severity of bleeding complications and the need to transfuse platelets and/or RBCs. If blinding cannot be adequately incorporated into the study design, other measures have been proposed to help minimize the potential for bias [28–30, 33]. In lieu of blinding the assessors, the Trial of Platelet Prophylaxis (TOPP) investigators [33] have opted to rely on such measures as educational meetings, widely distributed and common definitions for bleeding, as well as the undertaking of duplicate assessments.…”

Section: Methodsmentioning

confidence: 99%

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Meta‐analysis of the studies of bleeding complications of platelets pathogen‐reduced with the Intercept system

Vamvakas

2011

Vox Sanguinis

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“…In most studies the physical assessment was performed once in a 24‐hour period; however, one study performed assessment three times each day 9 . Independent research by two groups also investigated whether patients could accurately perform their own bleeding assessments 10,11 . Once the signs and symptoms of bleeding were collected, a grade using the WHO scale had to be applied.…”

mentioning

confidence: 99%