Feasibility and usefulness of self-assessment of bleeding in patients with haematological malignancies, and the association between platelet count and bleeding.
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.
Stanworth
S J
SJ
Department of Haematology, John Radcliffe Hospital, Headington, Oxford, UK. simon.stanworth@nbs.nhs.uk
Dyer
C
C
Casbard
A
A
Murphy
M F
MF
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