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Epistaxis duration predicts bleeding in immune thrombocytopenia: a cohort study
  1. Lianna Reynolds1,
  2. Benjamin David Williams2,
  3. John Grainger3
  1. 1Manchester University NHS Foundation Trust, Manchester, UK
  2. 2Blackpool Victoria Hospital, Blackpool, UK
  3. 3Royal Manchester Children’s Hospital, Manchester, UK
  1. Correspondence to Dr Lianna Reynolds, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK; lianna.reynolds{at}nhs.net

Abstract

Objective To test for an association between duration of epistaxis and clinically relevant bleeding in the following 12 months in children with immune thrombocytopenia (ITP).

Design Prospective cohort study.

Setting The national UK Paediatric ITP registry, a multicentre prospective clinical registry of new cases of ITP between 2006 and February 2020.

Patients All children aged between 2 months and 16 years in participating UK centres.

Exposure Epistaxis at presentation defined as none, <10 min, 10–30 min and >30 min.

Main outcome measures Incident severe bleeds, combined moderate and severe bleeds and drop in haemoglobin (Hb) by ≥20 g/L.

Results The sample included 1793 patients, of which 334 had epistaxis <10 min, 88 lasting 10–30 min and 97 >30 min. In the 12 months following presentation, 19 had a severe bleed, 140 had a moderate bleed and 54 had a drop in Hb ≥2 g/dL. Epistaxis >30 min duration was associated with increased odds of severe bleeds (OR 1.43–15.67), moderate or severe bleeding (OR 1.33–4.2) and drop in Hb (OR 1.23–6.91). Shorter duration epistaxis was not associated with increased odds of any outcome. A trend for increased odds with longer duration epistaxis was significant for all outcomes.

Conclusions The longer the duration of epistaxis at presentation with ITP, the higher the risk of a clinically significant bleeding event in the 12 months following. This should inform clinical severity ratings and treatment decisions.

  • paediatrics
  • child Health
  • pathology
  • paediatric emergency medicine

Data availability statement

Data may be obtained from a third party and are not publicly available. For enquiries about access to the data used in this study, please refer to https://www.uk-itp.org/index.htm.

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Data availability statement

Data may be obtained from a third party and are not publicly available. For enquiries about access to the data used in this study, please refer to https://www.uk-itp.org/index.htm.

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Footnotes

  • Contributors LR contributed to the conception and substantive design, data editing, interpretation of results and drafting and reviewing the manuscript; and approved the final version. BDW contributed to the design and conduct of the statistical analysis and drafting and reviewing the manuscript; and approved the final version. JG is the guarantor.

  • Funding This study was funded by ITP Patient Support Organisation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.