論文

査読有り 国際誌
2020年4月28日

Risk factors for skin, mucosal, and organ bleeding in adults with primary ITP: a nationwide study in Japan.

Blood advances
  • Takaaki Hato
  • ,
  • Naoki Shimada
  • ,
  • Yoshiyuki Kurata
  • ,
  • Masataka Kuwana
  • ,
  • Kingo Fujimura
  • ,
  • Hirokazu Kashiwagi
  • ,
  • Toshiro Takafuta
  • ,
  • Mitsuru Murata
  • ,
  • Yoshiaki Tomiyama

4
8
開始ページ
1648
終了ページ
1655
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1182/bloodadvances.2020001446

Bleeding manifestations in primary immune thrombocytopenia (ITP) range from skin petechiae to life-threatening intracranial hemorrhage (ICH). However, the relation between these various bleeding manifestations and the platelet count in ITP remains poorly characterized. Using a nationwide database of patients with ITP during the years 2005 to 2014 (10 years) in Japan, we analyzed 19 415 adult patients newly diagnosed with ITP, including 222 with ICH. The frequency of skin purpura was 64.8%, and this increased linearly with thrombocytopenia without a specific platelet count threshold. In contrast, mucosal bleeding (epistaxis and gingival bleeding) and organ bleeding (melena, hematuria, and ICH) increased exponentially with thrombocytopenia at a platelet count threshold of 10 to 15 × 109/L. Age showed a much weaker correlation than platelet count with skin and mucosal bleeding. However, the incidence of organ bleeding increased exponentially above 60 years of age. Multivariate analysis showed that the presence of mucosal bleeding was a risk factor for occurrence of melena and hematuria but not for ICH. The frequency of ICH was 1.1% and risk factors for ICH were age ≥60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 2.13-4.47; P < .001), platelet count <10 × 109/L (OR, 2.96; 95% CI, 2.11-4.15; P < .001), and the presence of hematuria (OR, 1.56; 95% CI, 1.04-2.35; P = .033). The relation between ICH and platelet count varied with age. This large-scale analysis of risk factors for bleeding in ITP has revealed distinct characteristics of skin, mucosal, and organ bleeding in adult patients with newly diagnosed ITP, thus indicating those who are at a high risk of severe organ bleeding.

リンク情報
DOI
https://doi.org/10.1182/bloodadvances.2020001446
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/32320469
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189281
ID情報
  • DOI : 10.1182/bloodadvances.2020001446
  • PubMed ID : 32320469
  • PubMed Central 記事ID : PMC7189281

エクスポート
BibTeX RIS