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Bleeding Risk Index in Patients with Malignant Lymphoma or Solid Tumors

Purpose: To identify a patient with malignant lymphoma or solid tumor who is likely to bleed following chemotherapy using the bleeding risk index of Elting et al.

Description

Elting et al developed a clinical prediction rule for identifying patients with malignant lymphoma or solid neoplasms who are at risk from hemorrhage associated with thrombocytopenia following chemotherapy. This can identify patients on day 1 of a chemotherapy cycle who are at risk for bleeding and may require platelet transfusion therapy. The authors are from M.D. Anderson Cancer Center in Houston.


Parameters:

(1) history of previous bleeding episodes

(2) current drug history

(3) bone marrow involvement

(4) baseline platelet count

(5) primary site of neoplasm

(6) Zubrod score (ECOG performance scale)

(7) chemotherapy regimen

 

Parameter

Finding

Points

history of previous bleeding episode

present

2

 

absent

0

current drug history

includes one or more of the following: penicillin, cephalosporin, antihistamine, heparin, tricyclic antidepressant, phenothiazine

2

 

none of the above

0

bone marrow metastasis

present

2

 

absent

0

baseline platelet count

< 75,000 per µL

2

 

>= 75,000 per µL

0

primary site of neoplasm

genitourinary or gynecologic

2

 

other

0

Zubrod score (ECOG performance scale)

3 or 4

2

 

0, 1 or 2

0

chemotherapy regimen

includes one or more of the following: cisplatin, carboplatin, carmustine, lomustine, dacarbazine, mitomycin C

1

 

none of the above

0

 

bleeding risk index =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum bleeding risk index: 0

• maximum bleeding risk index: 13

• A patient identified as high risk on the first day of a chemotherapy cycle is likely to require platelet product transfusion to control bleeding.

 

Bleeding Risk Index

Risk of Bleeding

0

low risk

1, 2 or 3

moderate risk

>= 4

high risk

 

Performance:

• Area under ROC curve: 0.83 in derivation set; 0.73 in validation set.

• Sensitivity for major bleeding was 80%; specificity for any bleeding was 84%.


 


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Specialty

Objective

ICD-10