Platelet Transfusions In Patients with Immune Thrombocytopenic Purpura (ITP) – Evaluation of the Current Nationwide Inpatient Hospital Practices.

The role of platelet transfusions in the management of immune thrombocytopenic purpura (ITP) is debatable. The 2010 international consensus guidelines on the diagnosis and management of ITP (Blood, 2010) recommends that platelet transfusions be reserved for use when an urgent restoration in platelet count is needed, such as for patients who are bleeding and those preparing for surgery. To date, the nationwide practices of platelet transfusion in hospitalized ITP patients in the US have not been reported.

This study aims to quantify the current nationwide in-hospital ITP related bleeding complications, platelet transfusion practices and the associated mortality rates.

Data from the Nationwide Inpatient Sample (NIS) 2007, the largest all-payer inpatient database in the U.S. were used. NIS is a powerful database which gives a stratified probability sample of 20% of all hospital discharges among U.S. community hospitals (n = 1,044). Sampling weights were applied to represent all community hospital discharges in the US in 2007. ITP was identified using the ICD9 code 287.31. ITP related major bleed was defined to include intracranial hemorrhage (ICH), gastrointestinal bleed (GIB) and/or genitourinary bleed (GUB).

In 2007, there were 50,275±1,596 hospital discharges with ITP as one of the all listed diagnoses. Of these, 4,016±520 were children (≤17years). Platelet transfusions were administered in 14.3±0.6% of the total discharges. Of the pediatric discharges, 4.8±0.9% received platelets. At least one major bleed occurred in 9.0±0.3% of the ITP discharges. Among those with a major bleed, 31.2±1.8% received platelets. Platelet transfusions occurred in 34.9±3.4% of patients with epistaxis, in the absence of a major bleed.

The mean age was 45.9±1.3 years for all hospitalized patient with ITP, 60.8±0.8 years for patients with a major bleed, and 58.3±0.7 years for recipients of platelet transfusions. For all patients with ITP, mortality rate was 3.6±2.0%.

Mortality rate of 9.5±1.0% among patients with a major bleed, was significantly higher (p <0.001) than those without a major bleed (3.0±0.2%). There was no significant difference in mortality rate (p= 0.12) between patients who had a major bleed and received platelets (11.8±2.0%) and those who had a major bleed and did not receive platelets (8.5±1.5%).

These data suggest that platelet transfusions are administered frequently in hospitalized patients with ITP in those who have bleeding complications and also in those who have epistaxis in the absence of a major bleed. Mortality rate is significantly higher in ITP patients with a major bleed as compared to those without a major bleed. Platelet transfusions in patients with major bleeds are not associated with improved mortality rates. The high rate of platelet transfusions with or without concomitant severe hemorrhage suggests the need for further studies to ascertain the role of platelet transfusion in the management of ITP.

No relevant conflicts of interest to declare.