According to results from a prospective trial (ClinicalTrials.gov identifier: NCT02783313) in the Netherlands published in the British Journal of Haematology, 2 easily measured biomarkers may be helpful in creating a prediction model for hemorrhage risk in patients with thrombocytopenia due to hematologic malignancy.
The need to predict hemorrhage in patients with thrombocytopenia due to hematologic malignancies is urgent as more than 40% of these patients will experience a bleeding event. However, predicting hemorrhage in these patients is challenging, with clinicians adhering to transfusion triggers to direct patients through the aplastic phase of chemotherapy. Although platelet count is associated with risk for hemorrhage, it is not the only factor affecting hemorrhage.
In this study, researchers prospectively evaluated correlations between biomarkers for inflammation, endothelial damage, and risk for bleeding in 88 patients with thrombocytopenia who experienced 116 on-protocol episodes. C-reactive protein (CRP) was used as the biomarker for inflammation, urine albumin excretion for endothelial damage, and World Health Organization grading for bleeding.
Mean patient age was 54 years. Treatment for different histologies included autologous transplant (57% of patients), remission induction chemotherapy (28% of patients), consolidation chemotherapy (10% of patients), and allogenic transplant (5% of patients).
A higher urine albumin/creatinine ratio 1 day after measurement was found to be associated with increased grade 2 bleeding (odds ratio [OR], 1.24 for every doubling of the ratio; 95% CI, 1.05-1.46; P =.01). Furthermore, a 29% increase in the odds of grade 2 hemorrhage occurred for every doubling of serum CRP (95% CI, 1.04-1.60; P =.02) after correction for morning platelet count.
Increased urine albumin/creatinine ratio and CRP was correlated with decreased 24-hour post-transfusion corrected count increment.
“The occurrence and quantity of albuminuria and CRP in thrombocytopenic patients are associated with a bleeding phenotype as well as with increased platelet consumption as shown by lower corrected count increments after platelet transfusions,” the researchers concluded. “How these biomarkers can be incorporated into a model to predict which patient will develop a clinically significant bleeding requiring additional platelet transfusion support or alternative strategies such as antifibrinolytic agents, remains to be studied.”
- Ypma PF, van Geloven N, Kerkhoffs JL, et al. The association between haemorrhage and markers of endothelial insufficiency and inflammation in patients with hypoproliferative thrombocytopenia: a cohort study [published online November 15, 2019]. Br J Haematol. doi: 10.1111/bjh.16291