Platelet reference ranges for neonates, defined using data from over 47 000 patients in a multihospital healthcare system

Abstract

Objective: Identifying a platelet count as abnormal (thrombocytopenia or thrombocytosis) can facilitate recognizing various disease states. However, the published reference ranges for platelet counts in neonates may be imprecise, as they were generated from relatively small sample sizes and compiled before modern platelet enumeration methods. Study design:We derived new neonatal reference ranges for platelet counts and mean platelet volume (MPV) measurements using electronic data accumulated during a recent 6-year period from a multihospital healthcare system.Result: Platelet counts were obtained between the first and the 90th day after birth, from 47 291 neonates delivered at 22 to 42 weeks gestation. The first platelet counts obtained in the first 3 days of life, increased over the range of 22 to 42 weeks gestation. In those born p32 weeks gestation, the lower reference range (5th percentile) was 104 200 ml À1 , but it was 123 100 ml À1 in late-preterm and -term neonates. Advancing postnatal age had a significant effect on platelet counts; during the first 9 weeks, the counts fit a sinusoidal pattern with two peaks; one at 2 to 3 weeks and a second at 6 to 7 weeks. The upper limit of expected counts (95th percentile) during these peaks were as high as 750 000 ml À1 . Conclusion:The figures herein describe reference ranges for platelet counts and MPV determinations of neonates at various gestational ages during their first 90 days. Expected values differ substantially from the 150 000 ml À1 to 450 000 ml À1 range previously used to define neonatal thrombocytopenia and thrombocytosis. The new definitions will render the diagnoses of neonatal thrombocytopenia and thrombocytosis less commonly than when the old definitions were used, because the new ranges are wider than 150 000 ml À1 to 450 000 ml À1 .

Association of cord blood platelet count and volume with hemoglobin in healthy term infants

“…25 Recently, PLT count and MPV reference ranges for the first 3 days of life were reported for neonates in a large, multi-hospital study. 26 The association of MPV and PLT count with Hb and RBC concentration of CB collections from healthy term infants is interesting. Animal studies have shown that the hematopoietic activity is strictly regulated genetically.…”

Early-Onset Thrombocytopenia in Small-for-Gestational-Age Neonates: A Retrospective Cohort Study

“…[21] Because several studies have shown that reference values of platelet count in fetuses reach adult values early in gestation, it is unlikely that this correlation is confounded by gestational age. [22] Associations between platelet count and birth weight have been demonstrated before, but these birth weight groups included both AGA and SGA neonates. [4] Our results suggest that the severity of SGA, and not birth weight alone, is correlated with neonatal platelet count.…”

Neonatal haemostasis and the management of neonatal thrombosis

“…The interaction between the endothelium and platelets is, to a large extent, dependent on the total number of platelets, their function and the activity of VWF. By 22 weeks gestation, the well fetus has a platelet count within the adult normal range at 247 AE 59 9 10 9 /l, which remains at similar levels until term (Forestier et al, 1991) but then rises during the first 9 week of life up to 750 9 10 9 /l (Wiedmeier et al, 2009). …”