Contributions
Abstract: EP1133
Type: E-Poster Presentation
Session title: Platelet disorders
Background
Immune thrombocytopenia (ITP) is an autoimmune condition characterised by a low platelet count (<100 x 109/L). Patients with ITP have an increased risk of bruising and bleeding. However, a few studies have shown that they also suffer from other symptoms (e.g. memory and concentration problems) that are not related to bleeding, suggesting that ITP patients might suffer from cognitive impairment.
Aims
The study hypothesis was that patients with ITP suffer from cognitive impairment. The aims were to establish what cognitive domains are impaired and what the prevalence of cognitive impairment in this population is. The secondary objective was to investigate the link between ITP disease parameters and cognitive impairment.
Methods
Seventy patients with ITP and a nadir platelet count ≤ 30 x 109/L were recruited to the study and were then invited to Hammersmith Hospital, London, for the following procedures: cognitive testing using an automated neuropsychological test battery (CANTAB), completion of SMOG bleeding questionnaire and full blood count. CANTAB is a validated automated software used in clinical practice and research to assess cognitive impairment. Five key cognitive domains (episodic memory, executive function, processing speed, working memory and attention) were assessed using different CANTAB tasks. The scores for each test were automatically processed by the software, and z-scores standardized for age, sex and education level were generated. Based on the z-scores, the patients’ cognitive performance was categorised as impaired or not impaired. The patients’ clinical metadata (including date of diagnosis, lowest platelet count recorded during the course of the disease, number of types of ITP treatments received and co-morbidities) was collected from paper and electronic medical records.
Results
The summary of the patients’ demographics and clinical characteristics is presented in Table 1.
Table 1. Demographics and clinical characteristics of the population studied
| Median (range) |
Age at the time of cognitive test, years | 40 (19, 88) |
Age at the time of ITP diagnosis, years | 40 (4, 83) |
Female, n (%) | 46 (65.7) |
Duration of disease, months | 67.5 (1, 535) |
Nadir platelet count, x 109/L | 5 (0, 30) |
Number of types of ITP treatments received during the course of the disease | 4 (0, 14) |
Platelet count at the time of test, x 109/L | 93 (4, 653) |
Patients receiving ITP treatment at the time of cognitive test, n (%) | 36 (51) |
Patients with co-morbidities, n (%) | 46 (65.7) |
Of the 70 patients tested, 50% (95 % CI [37.8%, 63.2%]) had at least one impaired cognitive domain: 30% had impairment in one domain, 17% in two domains and 3% in three domains. The frequency of cognitive impairment per domain is illustrated in Figure 1.
Organ bleeding was found to be associated with impaired episodic memory (p = 0.017). No other disease parameters were associated with impaired cognition.
Conclusion
Fifty percent of patients with ITP were found to have impaired cognition. Patients with higher organ bleeding scores were more likely to have impaired episodic memory. No other disease parameters, including duration of disease, or platelet count were associated with impaired cognition. These results suggest that ITP is not just a ‘low platelet’ disease.
Keyword(s): Autoimmune disease, Bleeding disorder, ITP
Abstract: EP1133
Type: E-Poster Presentation
Session title: Platelet disorders
Background
Immune thrombocytopenia (ITP) is an autoimmune condition characterised by a low platelet count (<100 x 109/L). Patients with ITP have an increased risk of bruising and bleeding. However, a few studies have shown that they also suffer from other symptoms (e.g. memory and concentration problems) that are not related to bleeding, suggesting that ITP patients might suffer from cognitive impairment.
Aims
The study hypothesis was that patients with ITP suffer from cognitive impairment. The aims were to establish what cognitive domains are impaired and what the prevalence of cognitive impairment in this population is. The secondary objective was to investigate the link between ITP disease parameters and cognitive impairment.
Methods
Seventy patients with ITP and a nadir platelet count ≤ 30 x 109/L were recruited to the study and were then invited to Hammersmith Hospital, London, for the following procedures: cognitive testing using an automated neuropsychological test battery (CANTAB), completion of SMOG bleeding questionnaire and full blood count. CANTAB is a validated automated software used in clinical practice and research to assess cognitive impairment. Five key cognitive domains (episodic memory, executive function, processing speed, working memory and attention) were assessed using different CANTAB tasks. The scores for each test were automatically processed by the software, and z-scores standardized for age, sex and education level were generated. Based on the z-scores, the patients’ cognitive performance was categorised as impaired or not impaired. The patients’ clinical metadata (including date of diagnosis, lowest platelet count recorded during the course of the disease, number of types of ITP treatments received and co-morbidities) was collected from paper and electronic medical records.
Results
The summary of the patients’ demographics and clinical characteristics is presented in Table 1.
Table 1. Demographics and clinical characteristics of the population studied
| Median (range) |
Age at the time of cognitive test, years | 40 (19, 88) |
Age at the time of ITP diagnosis, years | 40 (4, 83) |
Female, n (%) | 46 (65.7) |
Duration of disease, months | 67.5 (1, 535) |
Nadir platelet count, x 109/L | 5 (0, 30) |
Number of types of ITP treatments received during the course of the disease | 4 (0, 14) |
Platelet count at the time of test, x 109/L | 93 (4, 653) |
Patients receiving ITP treatment at the time of cognitive test, n (%) | 36 (51) |
Patients with co-morbidities, n (%) | 46 (65.7) |
Of the 70 patients tested, 50% (95 % CI [37.8%, 63.2%]) had at least one impaired cognitive domain: 30% had impairment in one domain, 17% in two domains and 3% in three domains. The frequency of cognitive impairment per domain is illustrated in Figure 1.
Organ bleeding was found to be associated with impaired episodic memory (p = 0.017). No other disease parameters were associated with impaired cognition.
Conclusion
Fifty percent of patients with ITP were found to have impaired cognition. Patients with higher organ bleeding scores were more likely to have impaired episodic memory. No other disease parameters, including duration of disease, or platelet count were associated with impaired cognition. These results suggest that ITP is not just a ‘low platelet’ disease.
Keyword(s): Autoimmune disease, Bleeding disorder, ITP