Thrombocytopenia and the effect of platelet transfusions on the occurrence of intracranial hemorrhage in patients with a
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ORIGINAL ARTICLE
Thrombocytopenia and the effect of platelet transfusions on the occurrence of intracranial hemorrhage in patients with acute leukemia – a nested case-control study Loes L. Cornelissen 1,2,3 & Aukje L. Kreuger 1,3 & Camila Caram-Deelder 1,3 & Rutger A. Middelburg 1,3 & Jean Louis H. Kerkhoffs 1,4 & Peter A. von dem Borne 5 & Erik A. M. Beckers 6 & Karen M. K. de Vooght 7 & Jürgen Kuball 8 & J. J. Zwaginga 1,2 & Johanna G. van der Bom 1,3 Received: 28 July 2020 / Accepted: 3 October 2020 # The Author(s) 2020
Abstract We designed a study to describe the incidence of intracranial hemorrhage according to severity and duration of thrombocytopenia and to quantify the associations of platelet transfusions with intracranial hemorrhage in patients with acute leukemia. In this casecontrol study nested in a cohort of 859 leukemia patients, cases (n = 17) were patients diagnosed with intracranial hemorrhage who were matched with control patients (n = 55). We documented platelet counts and transfusions for seven days before the intracranial hemorrhage in cases and in a “matched” week for control patients. Three measures of platelet count exposure were assessed in four potentially important time periods before hemorrhage. Among these leukemia patients, we observed the cumulative incidence of intracranial hemorrhage of 3.5%. Low platelet counts were, especially in the three to seven days preceding intracranial hemorrhage, associated with the incidence of intracranial hemorrhage, although with wide confidence intervals. Platelet transfusions during the week preceding the hemorrhage were associated with higher incidences of intracranial hemorrhage; rate ratios (95% confidence interval) for one or two platelet transfusions and for more than two transfusions compared with none were 4.04 (0.73 to 22.27) and 8.91 (1.53 to 51.73) respectively. Thus, among acute leukemia patients, the risk of intracranial hemorrhage was higher among patients with low platelet counts and after receiving more platelet transfusions. Especially, the latter is likely due to clinical factors leading to increased transfusion needs. Keywords Intracranial hemorrhage . Acute leukemia . Thrombocytopenia . Platelet transfusions . Case-control study
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04298-7) contains supplementary material, which is available to authorized users. * Johanna G. van der Bom [email protected]
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Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
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Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/ LUMC, Leiden, The Netherlands
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Department of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands
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Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
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Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
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Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
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Department of Cli
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