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Post-Transplant Complications

Acute bleeding and thrombocytopenia after bone marrow transplantation

Bone Marrow Transplantation volume 27, pages 65–72 (2001)Cite this article

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/l. 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/l were found in 13.5%, 11–20 × 109/l in 20.4%, and >20 × 109/l 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. Bone Marrow Transplantation (2001) 27, 65–72.

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Acknowledgements

We greatly thank Dr Michael Grever for his encouragement throughout the study; our special thanks to Pan Kongyan, Adriane Hill, and the members of the blood transfusion service, Steve Baust and Ana Ciappi. Many thanks to Dr Mohamed Shabooti, and Mariana Zahurak for their contributions. The work was funded in part by National Cancer Institute grant No. CA 15386, and by an Amgen unrestricted educational grant.

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Authors and Affiliations

  1. Johns Hopkins Cancer Center, Baltimore, MD, USA

    S Nevo, C Enger, E Hartley, ME Borinsky, V Swan, AK Fuller, HG Braine, TS Kickler & GB Vogelsang

  2. Department of Medicine, The University of Oklahoma, Health Sciences Center, Hematology-Oncology Section, Oklahoma City, OK, USA

    JN George

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Nevo, S., Enger, C., Hartley, E. et al. Acute bleeding and thrombocytopenia after bone marrow transplantation. Bone Marrow Transplant 27, 65–72 (2001). https://doi.org/10.1038/sj.bmt.1702717

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