Thrombocytopenia and platelet transfusion in the neonate

Cremer, Malte; Sallmon, Hannes; Kling, Pamela J.; Bührer, Christoph; Dame, Christof

doi:10.1016/j.siny.2015.11.001

Cited by 63 publications

(50 citation statements)

References 89 publications

(77 reference statements)

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“…Hyporegenerative thrombocytopenias were either congenital genetically based syndromes known to have hyporegenerative thrombocytopenia, 11 Trisomy 21, 18 and 13, 12 the hyporegenerative thrombocytopenia of small for gestational age (SGA) 13 or the hyporegenerative thrombocytopenia of birth asphyxia 14 . Consumptive thrombocytopenias were either immune-mediated (allo-immune or maternal autoimmune), or accompanying infection, necrotizing enterocolitis (NEC) or disseminated intravascular coagulation (DIC) 15 – 18 . Thrombocytopenias of indeterminate kinetic cause were those where none of the above associations were recognized.…”

Section: Methodsmentioning

confidence: 99%

The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias

et al. 2017

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OBJECTIVE: The immature platelet fraction (IPF) is a laboratory measurement analogous to the reticulocyte count, but reflecting the thrombopoietic state. Similar to a reticulocyte count, it can be expressed as a percent (IPF% = percent of platelets that are immature) or as an absolute number per μl blood;the immature platelet count (IPC = IPF% × platelets per μl of blood). STUDY DESIGN: Using a retrospective analysis of de-identified data from non-thrombocytopenic neonates, we created reference intervals for IPF% and IPC. We then tested the value of these measurements for categorizing thrombocytopenic neonates. RESULTS: New charts display reference intervals for IPF% and IPC on the day of birth according to gestational age, and during the first 90 days after birth. Neonates with hyporegenerative varieties of thrombocytopenias (syndromes, small for gestational age, birth asphyxia) had lower IPF% and IPC than did neonates with consumptive thrombocytopenias (immune-mediated, infection, disseminated intravascular coagulation, necrotizing enterocolitis;both P < 0.0001). CONCLUSION: The new reference interval charts can be used to recognize abnormal IPFs. The IPF parameters can help clarify the kinetic mechanism responsible for thrombocytopenias in neonates.

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Section: Methodsmentioning

confidence: 99%

The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias

et al. 2017

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“…After day 10, apheresis platelet concentrates from compatible HLA platelet donors were transfused whenever the platelet count was less than 30×10 9 /L. As reviewed by Cremer et al ,6 the current threshold for platelet transfusion varied among centres. The selected management at our institution of 15 mL/kg body weight with a trigger <30×10 9 /L platelet count was based on expert opinion.…”

Section: Case Presentationmentioning

confidence: 99%

Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies

Wendel¹,

Akkök

Kutzsche

2017

BMJ Case Reports

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Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant's father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum. Weak antibodies against HLA-B57 and HLA-B58 in sera from both twins supported NAIT as the most likely diagnosis. Platelet transfusion requirements of the twins lasted for 7 weeks. Transfusion of HLA-matched platelet concentrates was more efficacious to manage thrombocytopaenia compared with platelet concentrates from random donors. Platelet genotyping and determination of HLA antibody specificity are needed to select compatible platelet units to expedite safe recovery from thrombocytopaenia in NAIT.

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“…Incidence of thrombocytopenia is 1-5% in newborns at birth [25][26][27]. Thrombocytopenia may be caused by feto-maternal and neonatal conditions such as impaired platelet production, consumption and sequestration, and combined mechanisms [28][29][30][31]. Platelet transfusion is associated with several risks including infection, transfusion-related acute lung injury, transfusion-associated circulatory overload, alloimmunization, allergic reaction, and other complications.…”

Section: Plateletsmentioning

confidence: 99%

“…Platelet transfusion is associated with several risks including infection, transfusion-related acute lung injury, transfusion-associated circulatory overload, alloimmunization, allergic reaction, and other complications. Therefore, platelet should be given when clearly clinically indicated [31,32]. Reference values for normal platelet counts, especially lower limit, are important to diagnose thrombocytopenia.…”

Section: Plateletsmentioning

confidence: 99%

See 1 more Smart Citation

Reference Intervals of Platelets, Lymphocytes and Cardiac Biomarkers in Umbilical Cord Blood

Kim¹,

Hur²,

Moon³

et al. 2017

Umbilical Cord Blood Banking for Clinical Application and Regenerative Medicine

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The umbilical cord blood (UCB) can be used for early detection of neonatal diseases. The UCB can be used for early detection of neonatal diseases. Establishing reference intervals is essential for appropriate interpretation of results of laboratory tests using UCB and for correct medical decisions of pediatricians and neonatologists. The use of proper reference intervals provides reliable information to pediatricians and neonatologists; thus, they could make correct medical decisions for neonates. This chapter discussed reference intervals of platelets, lymphocytes, and cardiac biomarkers in UCB according to the Clinical Laboratory Standards Institute guidelines. Except iatrogenic anemia, thrombocytopenia is the most common hematologic abnormality in neonates. Immature platelet fraction is a novel parameter to estimate megakaryopoiesis and can be useful to understand the mechanism of thrombocytopenia, platelet destruction or bone marrow failure, in neonates. Lymphocyte counts, T cell and B cell, can relect status of immune system in fetus and neonates. Especially Tregs in UCB may contribute to maintain the immune homeostasis in the feto-maternal relationship, and the presence of Tregs would be essential to prevent immune dysregulation in fetus and neonates. Congenital heart disease or defect is the most common birth defect in newborns. Cardiac biomarkers are essential to evaluate heart function and to give information of myocardial injury, necrosis, or myocardial stretch. There are no current guidelines for their routine use in children.

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Thrombocytopenia and platelet transfusion in the neonate

Cited by 63 publications

References 89 publications

The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias

The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias

Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies

Reference Intervals of Platelets, Lymphocytes and Cardiac Biomarkers in Umbilical Cord Blood

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