Ontogeny of platelet function

Abstract

Although the hemostatic potential of adult platelets has been investigated extensively, regulation of platelet function during fetal life is less clear. Recent studies have provided increasing evidence for a developmental control of platelet function during fetal ontogeny. Fetal platelets feature distinct differences in reactive properties compared with adults. These differences very likely reflect a modified hemostatic and homeostatic environment in which platelet hyporeactivity contributes to prevent pathological clot formation on the one hand but still ensures sufficient hemostasis on the other hand. In this review, recent findings on the ontogeny of platelet function and reactivity are summarized, and implications for clinical practice are critically discussed. This includes current platelet-transfusion practice and its potential risk in premature infants and neonates.

Platelet Function Changes during Neonatal Cardiopulmonary Bypass Surgery: Mechanistic Basis and Lack of Correlation with Excessive Bleeding

“…The in vitro data reported in this study may therefore not faithfully represent the responses of which neonatal platelets are capable, especially given the well-established differences between neonatal and adult platelet phenotype and function. 53,54 Additional limitations of our study are that bleeding severity was assessed using only one definition of excessive bleeding and that the study included only a small number of patients. Future studies should be done to determine whether the findings reported herein are reproducible with other bleeding definitions (reviewed in Bercovitz et al 22 ) and whether they generalize to a larger, but equally well-characterized, group of neonatal cardiac surgery patients.…”

Platelets in Inflammation and Resolution

“…This observation might be caused by the fact that an increased inflammatory response induces more platelet adhesion in the microcirculation (12). Interestingly, also other factors, such as age (13)(14)(15), gender (16,17), and circadian rhythms (18,19), are known to affect platelet numbers and functions.…”

Platelet and red cell transfusions for neonates: lifesavers or Trojan horses?

“…This is important, as significant changes in cerebral blood flow and cerebral artery pressure are associated with increased risk of intracranial bleeding in neonates [13]. d. There is a high likelihood of a developmental mismatch between transfused adult platelets and the immature neonatal hemostatic system [14].…”