Specialist involvement is appropriate in ITP-associated bleeding to help assess other bleeding risk factors and to advise on use of therapies to increase the platelet count. There may be variation in the platelet count threshold below which different hematologists will initiate different treatments. Patient-specific factors such as age and other bleeding risk factors may also be incorporated into decision-making. A separate algorithm addresses ITP-associated thrombocytopenia without bleeding.
We use the following definitions, with selected examples:
- Critical bleeding – Bleeding into a critical anatomical site or bleeding that causes hemodynamic instability or respiratory compromise. Includes intracranial, intraspinal, intraocular, retroperitoneal, pericardial, or intramuscular bleeding with compartment syndrome.
- Severe bleeding – Bleeding that results in a fall in hemoglobin of 2 or more g/dL or requires transfusion of 2 or more units of pRBCs but does not meet the definition of critical bleeding.
- Minor bleeding – Bleeding that does not meet criteria for severe or critical bleeding. Examples include skin bleeding or non-severe mucous membrane bleeding.
