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.
