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Epistaxis duration predicts bleeding in immune thrombocytopenia: a cohort study
Lianna Reynolds1, Benjamin David Williams2, John Grainger3
1Manchester University NHS Foundation Trust, Manchester, UK lianna.reynolds@nhs.net.
Insights
Prolonged nosebleeds (epistaxis) in children with immune thrombocytopenia (ITP) indicate a higher risk of significant bleeding events within a year. This finding aids in assessing ITP severity and guiding treatment decisions.
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.
Objective:
To test for an association between duration of epistaxis and clinically relevant bleeding in the following 12 months in children with immune thrombocytopenia (ITP).
Design:
Prospective cohort study.
Setting:
The national UK Paediatric ITP registry, a multicentre prospective clinical registry of new cases of ITP between 2006 and February 2020.
Patients:
All children aged between 2 months and 16 years in participating UK centres.
Exposure:
Epistaxis at presentation defined as none, <10 min, 10-30 min and >30 min.
Main Outcome Measures:
Incident severe bleeds, combined moderate and severe bleeds and drop in haemoglobin (Hb) by ≥20 g/L.
Results:
The sample included 1793 patients, of which 334 had epistaxis <10 min, 88 lasting 10-30 min and 97 >30 min. In the 12 months following presentation, 19 had a severe bleed, 140 had a moderate bleed and 54 had a drop in Hb ≥2 g/dL. Epistaxis >30 min duration was associated with increased odds of severe bleeds (OR 1.43-15.67), moderate or severe bleeding (OR 1.33-4.2) and drop in Hb (OR 1.23-6.91). Shorter duration epistaxis was not associated with increased odds of any outcome. A trend for increased odds with longer duration epistaxis was significant for all outcomes.
Conclusions:
The longer the duration of epistaxis at presentation with ITP, the higher the risk of a clinically significant bleeding event in the 12 months following. This should inform clinical severity ratings and treatment decisions.
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