LAUSR

Severe thrombocytopenia (platelet count < 20 9 10/l) could cause spontaneous intracranial haemorrhage (ICH). Platelet count has been shown to be a poor predictor of haemorrhage in patients with haematological disorders. Cerebral microbleeds (CMBs) are defined as small perivascular haemosiderin deposits in brain identified as focal areas of signal loss <1 cm in size on T2W GRE (T2-weighted gradient echo) or SWI (susceptibility-weighted imaging) magnetic resonance imaging (MRI). The presence of CMBs could predict the risk of future spontaneous ICH. Due to a paucity of data regarding the prevalence of CMBs in patients with haematological disorders, we aimed to find any difference in the prevalence of CMBs in neurologically asymptomatic patients with severe thrombocytopenia due to aplastic anaemia (AA) and chronic immune thrombocytopenia (ITP) and the association of CMBs with subsequent spontaneous ICH. This prospective observational study was conducted in the department of internal medicine of a tertiary care hospital in north India. Patients (>12 years) diagnosed with idiopathic AA and chronic ITP and having platelet count < 20 9 10/ l were consecutively recruited over 18 months between January 2012 and June 2013. Pregnant females, patients with pre-existing coagulopathy, neurological disorder, history of ICH, patients taking non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents, antithrombotic agents, or any contra-indication for MRI were excluded from the study. At enrolment, eligible patients were subjected to SWI-MRI of brain. Patients with or without CMBs continued to receive the same standard-of-care treatment including platelet transfusions. Anti-hypertensive medications were administered for treatment-related hypertension. All the patients were followed up from the time of MRI till the end of the study period (June 2014). Patients were evaluated for spontaneous ICH using focused history and clinical examination directed at features of raised intracranial pressure, or any focal neurological deficit. Written and informed consent was obtained from the patients or their guardians prior to the enrolment. The study was approved by the institutional review board and was performed in accordance with the declaration of Helsinki. Data were analysed using SPSS software version 22 0 (IBM Corp., Armonk, NY, USA). All results are twotailed and a P value < 0 05 was considered significant (Data S1). Results