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Possible targets to reduce fatigue in chronic immune thrombocytopenia patients – an explorative study

1UMC Utrecht, Utrecht, Utrecht, Netherlands, 2Social Pediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands, Utrecht, Utrecht, Netherlands, 3Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public health research institute, Amsterdam, The Netherlands, Amsterdam, Noord-Holland, Netherlands, 4University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, Utrecht, Utrecht, Netherlands

Abstract Number: PB1213

Meeting: ISTH 2022 Congress

Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Acquired Thrombocytopenias

Background: Fatigue in immune thrombocytopenia (ITP) is frequent and burdensome, but we lack knowledge on how to help these patients.

Aims: To explore the role of disease activity in fatigue and identify potentially modifiable factors.

Methods: This cross-sectional study included adult chronic ITP patients. Univariate linear regression (corrected for confounders) was used to determine the relation between fatigue (Checklist Individual Strength fatigue subscale) and disease activity (high activity: platelet count < 30*10^9/L or current ITP treatment), disease-specific factors (bleeding symptoms (ITP-bleeding assessment tool), ferritin), and transdiagnostic (i.e. non-disease-specific) factors (physical, functional, emotional, and social well-being (Functional Assessment of Cancer Therapy-General (FACT-G) subscales), activity level, and 25-OH-vitamin-D). Several models with clustered sets of variables were used to compare the proportion of explained variance of fatigue (adjusted R2).

Results: We included 59 patients (mean age 45±18,4, median platelet count 61 (interquartile range 39-92), 61% was female, and 24% received current ITP treatment). Significant relations with fatigue with the largest effect size (>0,50) were found for physical and functional well-being, and activity. Other significant relations (effect size 0,30-0,47) included skin and organ bleeding, emotional and social well-being, vitamin D, and disease activity (Table I). Notably, the two clustered models with disease activity and disease-specific factors explained < 20% of the variance in fatigue, while the two clustered models with FACT-G subscales and activity level explained >50% (Table II). Vitamin D alone explained 12%.

Conclusion(s): Transdiagnostic (non-disease-specific) rather than disease-specific factors explained a large part of ITP-related fatigue. Many factors related to fatigue are potentially modifiable and should be investigated as potential targets for interventions.

Table

Table I Univariate linear analyses -corrected for confounders- for disease activity and each of potentially modifiable factors with fatigue as dependent variable

Table

Table II Multivariate models comparing the explained proportion of fatigue
for clustered sets of variables

To cite this abstract in AMA style:

van Dijk W, Nap-van der vlist M, Knoop H, Schutgens R. Possible targets to reduce fatigue in chronic immune thrombocytopenia patients – an explorative study [abstract]. https://abstracts.isth.org/abstract/possible-targets-to-reduce-fatigue-in-chronic-immune-thrombocytopenia-patients-an-explorative-study/. Accessed October 1, 2023.

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