[Comparative study between two bleeding grading systems of primary immune thrombocytopenia]

Predictive Value of High ICAM-1 Level for Poor Treatment Response to Low-Dose Decitabine in Adult Corticosteroid Resistant ITP Patients

Primary immune thrombocytopenia (ITP) is an autoimmune hemorrhagic disease. Endothelial cell activation/injury has been found in some autoimmune diseases including SLE, systemic sclerosis, and rheumatoid arthritis, but its role in ITP pathogenesis remains unclear. This study attempted to elucidate the correlation between endothelial dysfunction and disease severity of ITP and find related markers to predict response to low-dose decitabine treatment. Compared with healthy volunteers, higher plasma levels of soluble intercellular adhesion molecule-1 (ICAM-1), vascular endothelial growth factor (VEGF), and Angiopoietin-2 were found in adult corticosteroid resistant ITP patients. Notably, ICAM-1 levels were negatively correlated with the platelet count, and positively associated with the bleeding score. Recently, we have reported the efficacy and safety of low-dose decitabine in adult patients with ITP who failed for the first line therapies. Here, we evaluated the correlation of plasma ICAM-1 level with the efficacy of low-dose decitabine therapy for corticosteroid resistant ITP. A total of 29 adult corticosteroid resistant ITP patients who received consecutive treatments of low-dose decitabine were enrolled in this study. Fourteen patients showed response (nine showed complete response and five showed partial response). The levels of ICAM-1 before and after treatment were significantly higher in the non-responsive ITP patients than in the responsive patients. As shown in the multivariable logistic regression model, the odds of developing no-response to low-dose decitabine increased by 36.8% for per 5 ng/ml increase in plasma ICAM-1 level [odds ratio (OR) 1.368, 95% confidence interval (CI): 1.060 to 1.764]. In summary, this was the first study to elucidate the relationship between endothelial dysfunction and corticosteroid resistant ITP and identify the potential predictive value of ICAM-1 level for response to low-dose decitabine.

Comparative Study of the Clinical Application of 2 Bleeding Grading Systems for Pregnant Women With Immune Thrombocytopenia

Objective: To compare the clinical practicability of two bleeding grading systems (BGS) in pregnancy with Immune Thrombocytopenia (ITP). Methods: The clinical data of 154 cases were retrospectively analyzed with the 2016 version of the ITP Bleeding Scale (ITP-2016) and the ITP-specific bleeding assessment tool (ITP-BAT). The correlation between the two BGS and the relations among the platelet counts, gestational ages, and disease stages were respectively analyzed. Results: There is no significant difference between the two BGS in the patients’ ages, nor between the newly diagnosed and the persistent group or the chronic group, while the difference between the persistent and the chronic group was significant (P = 0.001; P = 0.001). There is a negative correlation between the bleeding grade and platelet count (r = -0.436; r = -0.390), while the correlation between the two BGS was positive (r = 0.921). The proportions of identical scores provided by two different physicians using the two BGS were 94.8% and 93.5%. The difference before and after the treatment were significantly different (P = 0.013; P = 0.037). It takes less time to score with the ITP-2016 (P = 0.011). Conclusion: Both systems can be useful for disease evaluations, risk assessments and efficacy evaluations in Chinese pregnant women with ITP. The ITP-2016 takes less time and is more suitable for Chinese pregnant patients with ITP.

Chinese guidelines for treatment of adult primary immune thrombocytopenia

Primary immune thrombocytopenia (ITP) is a bleeding disorder commonly encountered in clinical practice. The International Working Group (IWG) on ITP has published several landmark papers on terminology, definitions, outcome criteria, bleeding assessment, diagnosis, and management of ITP. The Chinese consensus reports for diagnosis and management of adult ITP have been updated to the 4th edition. Based on current consensus positions and new emerging clinical evidence, the thrombosis and hemostasis group of the Chinese Society of Hematology issued Chinese guidelines for management of adult ITP, which aim to provide evidence-based recommendations for clinical decision making.