Webert et al evaluated thrombocytopenic patients with acute myeloid leukemia (AML) for risk factors associated with bleeding. These can help to identify a patient who may benefit from more aggressive management. The authors are from McMaster University, University of Waterloo, University of Toronto and Ospedale Maggiore Policlinico (Milan).

Patient selection: AML patient with thrombocytopenia after induction chemotherapy

Patient exclusion: promyelocytic leukemia, secondary AML


Outcome: bleeding by WHO severity grades


Risk factors for severe bleeding (WHO Grades 3 to 4):

(1) rise in body temperature >= 38.0°C for Grades 3 or 4

(2) mild bleeding (WHO Grade 1 or 2) on the previous day


A higher hemoglobin value was associated with a delay in time to the first clinically significant bleed.


Risk factors for mild bleeding:

(1) clinical infection

(2) rise in body temperature


Factors protective against mild bleeding:

(1) antifungal medication

(2) platelet transfusion


These findings may support:

(1) platelet transfusion at higher platelet concentration threshhold if the patient is febrile, has signs of infection or mild bleeding

(2) monitoring and maintaining hemoglobin concentrations


On the other hand a lower platelet concentration threshold (10,000 per µL) may be relevant for a patient without any risk factor.

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