Comparative Study Of Clinical Application With Two Bleeding Grading Systems In Pregnancy With Immune Thrombocytopenic Purpura

Objective:To study the validity and clinical value of two bleeding grading systems.Methods:The clinical data of 154 cases of pregnancy with immune thrombocytopenic purpura(ITP)in Union Hospital of Fujian Medical University from April,2013 to July,2018 were retrospectively analyzed,The ITP bleeding scale of version 2016 and ITP specific bleeding assessment tool(ITP-BAT)were used to grade severity of the bleeding,and the correlation between the two bleeding grading systems and platelet counts,gestational age,disease stage,and their correlations were respectively analyzed.Eighty-two patients who had undergone hormone or gamma globulin therapy were scored using the two bleeding grading systems before and after treatment,and bleeding score changes and platelet counts analysis were performed to assess their response.Results:There was no significant difference between the two bleeding grading systems during different gestational age(?~2=2.463,P=0.651;?~2=4.455,P=0.108);While that between the different phases of the disease was statistically significant(?~2=13.34,P=0.001;?~2=14.446,P=0.001).There was no statistical difference between newly diagnosed group and persistent group(P=0.431,P=0.420),the same as that between newly diagnosed group and chronic group(P=1,P=1),but there was statistical difference between persistent group and chronic group(P=0.001,P=0.001).There was both a negative correlation between bleeding grade and platelet counts(r=-0.436,P<0.001;r=-0.390,P<0.001).While the correlation between the two bleeding grades was postive(r=0.921,P<0.001).The proportions of identical scores using the two bleeding scoring systems by two different physicians at the same time were 94.8%(K=0.894,P<0.001)and 93.5%(K=0.868,P<0.001),respectively.The platelet count of 82 patients before and after treatment with hormone and/or gamma globulin had significant difference(Z=-7.781,P<0.001),there was significant difference in two bleeding scores before and after treatment(Z=-2.497,P=0.013;Z=-2.082,P=0.037).The time required for scoring by the two grading systems was significantly different(Z=-2.546,P=0.011),It takes less time to score with the 2016ITP Bleeding Score Scale.Conclusion:The two bleeding scoring systems have good responsiveness,relevance,and consistency in clinical applications;The two bleeding scoring systems have nothing to do with different gestational ages,are associated with different disease stages,and are negatively correlated with platelet counts;The two bleeding scores are consistent in the application of different professional doctors;Pregnancy with ITP patient is effective after hormone and(or)gamma globulin therapy;Both bleeding scoring systems can be used as an effective tool for disease judgment,risk assessment and efficacy evaluation in patients with pregnancy and ITP.The former takes less time and is more suitable for Chinese ITP patients.