Bleeding frequency during physiotherapy in thrombocytopenic patients undergoing hematopoietic stem cell transplantation

Erick Alvaro Grencheski,Renato Fraga Righetti,Wellington Pereira Yamaguti,Margarete Noriko Kochi,Flávia Vanessa Aurea Politi,Tabata Maruyama Dos Santos,Christina May Moran De Brito,Benigno C Valdez

doi:10.1371/journal.pone.0255413

Erick Alvaro Grencheski, Renato Fraga Righetti + Show 6 more

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https://doi.org/10.1371/journal.pone.0255413

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Abstract

BackgroundDuring hematopoietic stem cell transplantation (HSCT) the patients perform activities of low and moderate intensity because have reduced hematological lineages, leaving them susceptible to hemorrhagic events. The objective of this study was to describe the frequency of bleeding events, severity, and possible association with physical exercise in thrombocytopenic patients.MethodsA retrospective study with seventy-seven HSCT patients hospitalised, that had a platelet count ≤ 50,000 /μL and received physical exercise during physiotherapy intervention.ResultsRegarding bleeding events, only six were related to physical exercise, and bleeding events occurred more frequently at platelet levels ≤ 10,000 /μL. The most frequent bleeding event was epistaxis, considered of low severity, and with the moderate possibility of being related to physical exercise; followed by extremity hematoma, considered of medium severity and highly related to physical exercise. In this study, there was no occurrence of bleeding events considered of high severity.ConclusionBleeding frequency in supervised physical exercise during physiotherapy in adults with thrombocytopenia undergoing HSCT is minor and relatively rare but occurs more frequently in patients with platelet count ≤10,000 /μL. These results encourage the maintenance of physical activity in this population who is at high risk of developing immobility-related complications.

Highlights

Hematological neoplasms comprise a wide category of alterations that affect the functioning of the bone marrow and lymphoid organs, compromising the production and function of hematopoietic cells [1, 2]
There was no occurrence of bleeding events considered of high severity
Bleeding frequency in supervised physical exercise during physiotherapy in adults with thrombocytopenia undergoing hematopoietic stem cell transplantation (HSCT) is minor and relatively rare but occurs more frequently in patients with platelet count 10,000 /μL. These results encourage the maintenance of physical activity in this population who is at high risk of developing immobility-related complications

Summary

Introduction

Hematological neoplasms comprise a wide category of alterations that affect the functioning of the bone marrow and lymphoid organs, compromising the production and function of hematopoietic cells [1, 2]. The treatment of hematological malignancies involves intense medical regimens, and in some cases, Hematopoietic Stem Cell Transplantation (HSCT), resulting in extended periods of hospitalization, high risk of infection and re-hospitalizations, interfering with biological, psychological and social aspects of patients and family members [2, 4]. The time of prolonged inactivity causes the decline of physical and functional capacity, affecting the quality of life of the patient [5, 6]. These patients develop severe thrombocytopenia, increasing their predisposition to bleeding [7, 8]. The objective of this study was to describe the frequency of bleeding events, severity, and possible association with physical exercise in thrombocytopenic patients

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