Low platelet count increases risk of bleeding complications in children with cancer: JAMA

USA: Pediatric cancer patients with a platelet count below 50 × 10³/μL may experience higher rates of minor bleeding complications during catheter placement, according to a study that was published in the Journal for American Medical Association.

Thrombocytopenia is a condition where the blood platelet count decreases. It affects blood clotting and the patients are susceptible to excessive bruising and even bleeding in severe cases. Pediatric cancer patients with thrombocytopenia are at high risk for bleeding complications, especially during catheter placement. Tunneled central venous catheters (CVCs) are frequently required in pediatric patients with cancer to give IV nutrition or medicines safely at home. It is inserted into one of the large veins of the body. However, data on platelet transfusion thresholds in this population are limited.

With this background, investigators at the Department of Surgery of the University of California collaborated with the Division of Pediatric Surgery of the Shriners Hospital for Children Northern California to study the bleeding complications in pediatric patients with a platelet count of 50 × 10³/μL or above vs below 50 × 10³/μL.

In a retrospective cohort study, they studied 235 patients younger than 18 years(median age 6 years) who had cancer and underwent CVC placement at a tertiary pediatric hospital between January 1, 2014, and December 31, 2019. Bleeding was classified as minor if there was documentation of a hematoma or oozing requiring pressure or a topical hemostatic agent. Bleeding was classified as major if the patient required red blood cell transfusion, return to the operating room or any invasive procedure for bleeding. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline was used. Statistical analysis was performed using the Kruskall-Wallis test, χ² test, and multivariable logistic regression were used.

The study revealed the following findings:

• Of patients with a platelet count below 50 × 10³/μL, 13 (59.1%) received a planned intraoperative platelet transfusion.
• The overall incidence of perioperative bleeding was 3.2% (n = 9).
• Minor bleeding occurred at higher rates in patients with platelet counts below 50 × 10³/μL (3 patients [13.6%] vs 3 [1.2%]). Major bleeding occurred in 3 patients (1.1%), and all of these episodes occurred in patients with platelet counts of 50 × 10³/μL or above.

The study shows that only a preoperative platelet count below 50 × 10³/μL was a significant risk factor for perioperative bleeding complications.

"A platelet count below 50 × 10³/μL may be associated with increased rates of minor bleeding complications in pediatric patients with cancer; however, major bleeding complications are rare and may not be associated with this threshold," the investigators concluded. 

Reference:

The study titled, "Association of Thrombocytopenia With Bleeding Risk During Central Venous Catheter Placement in Pediatric Patients With Cancer," is published in the journal JAMA Surgery.

DOI: https://jamanetwork.com/journals/jamasurgery/fullarticle/2781489