The association between haemorrhage and markers of endothelial insufficiency and inflammation in patients with hypoproliferative thrombocytopenia: a cohort study

Paula F. Ypma*, Nan van Geloven, Jean Louis H. Kerkhoffs, Peter te Boekhorst, Jaap J. Zwaginga, Erik A. M. Beckers, Anneke Brand, Pieter F. van der Meer, Jeroen C. J. Eikenboom

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

Abstract

In daily haematological practice, predicting bleeding in thrombocytopenic patients is difficult, and clinicians adhere to transfusion triggers to guide patients through the aplastic phase of chemotherapy. Platelet count is not the only determinant of bleeding and additional mechanisms for impending haemostasis are likely. Beside clot formation, platelets are essential for the maintenance of integrity of vascular beds. We therefore prospectively investigated associations between biomarkers for endothelial damage (urine albumin excretion) and inflammation (C-reactive protein) and bleeding (WHO grading) in 88 patients with 116 on-protocol episodes. We found an increase in grade 2 bleeding with a higher urine albumin/creatinine ratio one day after the measurement [odds ratio (OR) 1 center dot 24 for every doubling of the ratio, 95% CI 1 center dot 05-1 center dot 46, P-value 0 center dot 01] and a 29% increase in the odds of grade 2 bleeding for every doubling of serum C-reactive protein (CRP) (95% CI 1 center dot 04-1 center dot 60, P-value 0 center dot 02) after correction for morning platelet count. The 24 h post-transfusion corrected count increment (CCI24) showed a significant association with these biomarkers: increasing urine albumin/creatinine ratio and CRP were associated with lower CCI24. We report two inexpensive and easy-to-apply biomarkers that could be useful in designing a prediction model for bleeding risk in thrombocytopenic patients.

Original languageEnglish
Pages (from-to)171-181
Number of pages11
JournalBritish Journal of Haematology
Volume189
Issue number1
Early online date15 Nov 2019
DOIs
Publication statusPublished - Apr 2020

Keywords

  • haemorrhage
  • platelet transfusion
  • thrombocytopenia
  • microalbuminuria
  • CRP
  • C-REACTIVE PROTEIN
  • PLATELET-TRANSFUSION
  • HEMATOLOGICAL MALIGNANCIES
  • RISK
  • MICROALBUMINURIA

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