Thrombocytopenia in late preterm and term neonates after perinatal asphyxia

Christensen, Robert D.; Baer, Vickie L.; Yaish, Hassan M.

doi:10.1111/trf.12777

Cited by 38 publications

(26 citation statements)

References 28 publications

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“…The molecular mechanisms resulting in the “thrombocytopenia of SGA” may be similar to that causing the “thrombocytopenia of perinatal asphyxia” [25]. We suspect that fetal hypoxia is causally involved in both varieties, which is consistent with the studies of McDonald et al .…”

Section: Discussionsupporting

confidence: 85%

Thrombocytopenia in Small-for-Gestational-Age Infants

et al. 2015

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BACKGROUND Thrombocytopenia is common among small for gestational age neonates (SGA; birth weight <10th % reference range) but several aspects of this thrombocytopenia are unclear, including the incidence, typical nadir, duration, association with preeclampsia, mechanism, and risk of death. METHODS Using nine years of multihospital records we studied SGA neonates with ≥2 platelet counts <150,000/μL in their first week. RESULTS We found first-week thrombocytopenia in 31% (905 of 2891) of SGA neonates vs. 10% of non-SGA matched-controls (p<0.0001). One hundred-two of the 905 had a recognized cause of thrombocytopenia (DIC, early-onset sepsis, ECMO). This group had a 65% mortality rate. The remaining 803 did not have an obvious cause for their thrombocytopenia. We termed these the “thrombocytopenia of SGA”. They had a mortality rate of 2% (p<0.0001) and a mean nadir count on day 4 of 93,000/μL (standard deviation, 51,580/μL, 10th % 50,000/μL, 90th % 175,000/μL). By day 14, platelet counts were ≥150,000/μL in >half of the patients. Severely SGA neonates (<1st %) had lower counts and longer thrombocytopenia duration (p<0.001). High nucleated red cell counts at birth correlated with low platelets (p<0.0001). Platelet transfusions were given to 23% and counts typically >tripled. Thrombocytopenia was associated with SGA status more so than with the diagnosis of maternal preeclampsia. CONCLUSIONS SGA neonates with clearly recognized varieties of thrombocytopenia have a high mortality rate. In contrast the “thrombocytopenia of SGA” is a hyporegenerative condition of moderate severity and two weeks duration, associated with evidence of intrauterine hypoxia, and associated with a low mortality rate.

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Section: Discussionsupporting

confidence: 85%

Thrombocytopenia in Small-for-Gestational-Age Infants

et al. 2015

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“…The molecular mechanisms resulting in the "thrombocytopenia of SGA" may be similar to that causing the "thrombocytopenia of perinatal asphyxia" [25]. We suspect that fetal hypoxia is causally involved in both varieties, which is consistent with the studies of McDonald et al in t adult mice subjected to hypoxia [26], and marrow culture studies of Saxonhouse et al [27,28].…”

Section: Discussionsupporting

confidence: 80%

Thrombocytopenia in Small-for-Gestational-Age Infants

2015

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“…Neonates with thrombocytopenia were categorized into the following three groups, based on the presumed mechanism of the thrombocytopenia: (1) hyporegenerative, (2) consumptive or (3) indeterminate. 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 .…”

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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Thrombocytopenia in late preterm and term neonates after perinatal asphyxia

Cited by 38 publications

References 28 publications

Thrombocytopenia in Small-for-Gestational-Age Infants

Thrombocytopenia in Small-for-Gestational-Age Infants

Thrombocytopenia in Small-for-Gestational-Age Infants

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

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