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DDW 2020: Platelet Threshold and Adverse Events After Endoscopy in SCT Recipients

By: Cordi Craig
Posted: Wednesday, May 13, 2020

To decrease the risk of bleeding and infection of the gastrointestinal tract in patients who have undergone allogeneic hematopoietic stem cell transplant (SCT), current guidelines recommend platelet counts higher than 50x103/µL and absolute neutrophil counts of 500 cells/µL. However, Trilokesh Kidambi, MD, of the City of Hope National Medical Center, Los Angeles, and colleagues found that although patients with platelet counts higher than 50x103/µL appeared to have lower odds of adverse outcomes after endoscopy, the risks associated with it were low overall. The findings were presented as part of the 2020 virtual Digestive Disease Week (DDW; Abstract Tu1078).

Using an institutional database to evaluate for graft-versus-host disease, the researchers identified 159 endoscopies performed on patients who underwent hematopoietic SCT for hematologic malignancies. The procedures included upper endoscopy, flexible sigmoidoscopy, and colonoscopy. Adverse outcomes were defined as bleeding or infection within 1 week or death within 1 month of undergoing an endoscopy.

The most common diagnoses for patients following the endoscopies included acute myeloid leukemia (34.6%), B-cell acute lymphocytic leukemia (18.9%), and chronic myeloid leukemia (8.8%). The study team found that the most common indications of graft-versus-host disease were diarrhea (66.0%), nausea or vomiting (39.6%), and abdominal pain (19.5%).

Within 1 week, five patients (3.1%) experienced bleeding after the endoscopy procedures, and seven deaths (4.4%) were recorded within 1 month of the procedures. Patients who had a platelet count that was higher than 50 x 103/µL before the endoscopic procedure had a significantly lower risk of adverse events afterward (P = .04) than those with lower platelet counts. Similarly, patients who had high hemoglobin levels before the endoscopic procedure also had lower odds of adverse events afterward (P = .01). However, absolute neutrophil counts before the endoscopic procedure did not seem to be associated with adverse outcomes.

Disclosure: The study authors reported no conflicts of interest.

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