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Supportive Care in Cancer

, Volume 26, Issue 9, pp 3135–3141 | Cite as

Bleeding frequency and characteristics among hematologic malignancy inpatient rehabilitation patients with severe thrombocytopenia

  • Jack B. Fu
  • Jegy M. Tennison
  • Isabel M. Rutzen-Lopez
  • Julie K. Silver
  • Shinichiro Morishita
  • Seyedeh S. Dibaj
  • Eduardo Bruera
Original Article

Abstract

Objective

To identify the frequency and characteristics of bleeding complications during acute inpatient rehabilitation of hematologic malignancy patients with severe thrombocytopenia.

Design

Retrospective descriptive analysis.

Setting

Comprehensive cancer center acute inpatient rehabilitation unit.

Participants

Consecutive hematologic malignancy patients with a platelet count of less than or equal to 20,000/microliter (μL) on the day of acute inpatient rehabilitation admission from 1/1/2005 through 8/31/2016.

Interventions

Medical records were retrospectively analyzed for demographic, laboratory, and medical data. Patients were rehabilitated using the institutional exercise guidelines for thrombocytopenic patients.

Main outcome measures

Bleeding events noted in the medical record.

Results

Out of 135 acute inpatient rehabilitation admissions, 133 unique patients were analyzed with a total of 851 inpatient rehabilitation days. The mean platelet count was 14,000/μL on the day of admission and 22,000/μL over the course of the rehabilitation admission. There were 252 days of inpatient rehabilitation where patients had less than 10,000/μL platelets. A total of 97 bleeding events were documented in 77/135 (57%) admissions. Of the 97 bleeding events, 72 (74%), 14 (14%), and 11 (11%) were considered to be of low, medium, and high severity, respectively. There were 4/97 (4%) bleeding events that were highly likely attributable to physical activity but only 1/4 was considered high severity. Bleeding rates were .09, .08, .17, and .37 for > 20,000, 15–20,000, 10–15,000, and < 10,000/μL mean platelet counts respectively (p = .003). Forty-four percent of patients were transferred back to the primary acute care service with infection being the most common reason for transfer.

Conclusions

This study is the first to examine exercise-related bleeding complications during acute inpatient rehabilitation in severely thrombocytopenic hematologic cancer patients. Bleeding rates increased with lower platelet counts. However, using the exercise guidelines for severely thrombocytopenic patients, the risk of severe exercise-related bleeding events was low.

Keywords

Thrombocytopenia Cancer Rehabilitation Physical activity Exercise 

Notes

Funding information

This study was supported in part by the M.D. Anderson Cancer Center support grant # CA 016672.

Compliance with ethical standards

The approval for this study was obtained from the institutional review board (IRB). A waiver of informed consent was granted by the IRB in compliance with federal and institutional guidelines.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jack B. Fu
    • 1
  • Jegy M. Tennison
    • 1
  • Isabel M. Rutzen-Lopez
    • 1
  • Julie K. Silver
    • 2
  • Shinichiro Morishita
    • 3
  • Seyedeh S. Dibaj
    • 4
  • Eduardo Bruera
    • 1
  1. 1.Department of Palliative, Rehabilitation & Integrative Medicine, Unit 1414University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Physical Medicine & RehabilitationHarvard Medical School & Spaulding Rehabilitation HospitalBostonUSA
  3. 3.Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigataJapan
  4. 4.Department of BiostatisticsUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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