Webert et al identified risk factors associated with bleeding in a patient with acute myeloid leukemia (AML), who is thrombocytopenic because of cytotoxic agents. These can help identify a patient who may benefit from more aggressive management. The authors are from McMaster University, University of Waterloo, University of Toronto and Foundation IRCCS Ospedale Maggiore Policlinico (Milan).
Patient selection: AML with severe thrombocytopenia
• The authors demonstrated that mild bleeding was a risk factor for severe bleeding.
• Drugs and illnesses (like uremeia) that interfere with platelet function might be another risk factor for bleeding.
• The presence of clinical infection was a risk factor for mild bleeding with a p =0.05 (Table 3, page 1533).
• Bleeding was graded using the WHO criteria, with severe bleeding Grades 3 or 4.
• The study population was divided into 2 groups. One had a platelet transfusion threshold of 10,000 per µL while the other had a threshold of 20,000 per µL.
A patient with several risk factors may benefit from a more liberal platelet transfusion policy.
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