title: Feasibility and usefulness of self-assessment of bleeding in patients with haematological malignancies, and the association between platelet count and bleeding.
abstract: OBJECTIVE
  The aim of this study was to evaluate the collection of daily prospective information about bleeding outcomes in patients with thrombocytopenia, including information obtained by patient self-assessment.
  
  
  METHODS
  Consecutive patients with haematological malignancies were enrolled in a study of bleeding data collection during the period of thrombocytopenia. A short educational session and information sheet was designed for self-assessment. Platelet counts and all transfusions were recorded daily. Bleeding scores were translated into World Health Organization (WHO) bleeding grades.
  
  
  RESULTS
  Nineteen patients were included in the study. Four-hundred and ten days of thrombocytopenia were eligible for assessment of bleeds. Self-assessment was feasible, as defined by the total proportion of days on which self-assessment was completed (70%, 288 thrombocytopenic days). There was 86% agreement between bleeding data collected by self-assessment and by medical examination using a structured assessment form. Examples of discrepancies included the duration of petechiae/bruises and the reporting of minor bleeding. There was no evidence for an association between patients' morning platelet count and daily WHO bleeding grade. The incidences of WHO grade 1 and grade 2 bleeding on days with platelet counts < or = 10 x 10(9)/l, 11-20 x 10(9)/l, and > 20 x 10(9)/l were similar and did not reveal higher rates of bleeding at lower counts.
  
  
  CONCLUSIONS
  Patient self-assessment can help to support comprehensive daily prospective monitoring of bleeding, specifically facilitating data collection following hospital discharge. The discrepancies between self-assessment and medical examination highlight the need to develop a validated international assessment tool. The association among platelet count, risk of bleeding and role of prophylactic platelet transfusions needs further evaluation in larger prospective trials.
authors.affiliation: Department of Haematology, John Radcliffe Hospital, Headington, Oxford, UK. simon.stanworth@nbs.nhs.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Stanworth
authors.forename: C
authors.initials: C
authors.lastname: Dyer
authors.forename: A
authors.initials: A
authors.lastname: Casbard
authors.forename: M F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications / Q000628:therapy; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010976:Platelet Count; D017713:Platelet Transfusion; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology / Q000628:therapy