Epistaxis duration predicts bleeding in immune thrombocytopenia: a cohort study

Area of Science:

• Pediatric Hematology
• Clinical Research
• Bleeding Disorders

Background:

• Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet counts, increasing bleeding risk.
• Epistaxis is a common symptom in children with ITP, but its association with future bleeding severity is not well-defined.

Purpose of the Study:

• To investigate the relationship between the duration of epistaxis at presentation and the occurrence of clinically relevant bleeding events in children with ITP over a 12-month period.

Main Methods:

• A prospective cohort study was conducted using data from the national UK Paediatric ITP registry (2006-2020).
• Included were 1793 children (2 months to 16 years) with ITP, categorizing epistaxis duration at presentation (<10 min, 10-30 min, >30 min).
• Outcomes assessed included severe bleeds, moderate/severe bleeds, and hemoglobin drop (≥2 g/dL) within 12 months.

Main Results:

• Children with epistaxis lasting over 30 minutes had significantly increased odds of severe bleeds (OR 1.43-15.67), moderate/severe bleeds (OR 1.33-4.2), and hemoglobin drop (OR 1.23-6.91).
• No increased bleeding risk was associated with shorter epistaxis durations.
• A significant trend showed higher bleeding risk with longer epistaxis duration for all assessed outcomes.

Conclusions:

• The duration of epistaxis at presentation in children with ITP is a significant predictor of subsequent clinically relevant bleeding.
• Findings support using epistaxis duration to inform clinical severity assessments and treatment strategies for pediatric ITP.