PB1036 - Determinants of bleeding in chemotherapy induced thrombocytopenia in haemato-oncological patients: protocol for a systematic review.

Background: Bleeding in chemotherapy induced thrombocytopenia (CIT) in haemato-oncological patients is a significant problem. Clinical practice and research show that some patients don’t bleed despite low platelet counts, whereas others bleed even with prophylactic platelet transfusions. Other relevant factors might play a role in bleeding tendency of these patients, for example endothelial dysfunction, platelet function disorder or changes in the fibrinolytic pathway. Many studies on the effect of different possible factors have been reported, however no systematic review on this topic has been published yet.

Aims: The objective of our study is to systematically review the literature for evidence of exploring factors influencing bleeding in CIT in haemato-oncological patients. Our secondary aim is to determine the most promising areas of research in this field as a starting point for future investigations.

Methods: Studies involving adult haemato-oncological patients with CIT are included. Because of the specific influences on the coagulation system, studies exclusively focusing on patients with acute promyelocytic leukemia and pegasparaginase treatment are excluded. Outcomes of interest are laboratory and clinical factors related to bleeding. Our search strategy includes terms related to CIT, thrombocytopenia in combination with haemato-oncological patients, and bleeding. We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Inclusion of studies and data extraction are performed by two separate reviewers.

Results: 3446 potentially relevant abstracts were identified through our search. 3344 were excluded because of wrong outcome, population or language. Of the 102 remaining abstracts , 47 were conference abstract only. 55 articles are being assessed for full text eligibility. Laboratory and clinical parameters related to bleeding will be used for results.

Conclusion(s): There is still much uncertainty regarding determinants of bleeding in CIT in haemato-oncological patients. This review aims to summarize existing evidence and identify the most promising directions for feature research.