The evaluation of reasons for early and late onset neonatal thrombocytopenia in our new born intensive care unit

Year 2015, Volume: 6 Issue: 4, 121 - 125, 09.12.2015

Nilüfer Güzoğlu , Nagihan Akıcı Kara Didem Aliefendioğlu

Abstract

Aim: Thrombocytopenia is a common hematologic problem in the neonatal period. The aim of the study is determine of prevalence and reasons of thrombocytopenia in patients in our newborn intensive care unit (NICU).

Material and Methods: Medical records of patients who were hospitalized in NICU between January 2011 and May 2014 were inspected retrospectively. Early thrombocytopenia was identified as thrombocytopenia developing within first 72h’s of life and late thrombocytopenia was identified as thrombocytopenia developing after the first 72h’s of life. Demographic characteristics, clinical and laboratory parameters of the patients’ were recorded.

Results: The prevalence of thrombocytopenia was 11% in the study period. The reasons of early thrombocytopenia were placental insufficiency (n=14), with one patient having accompanying chromosomal anomaly, sepsis (n=14), maternal thrombocytopenia (n=7), perinatal asphyxia (n=6), and hemophagocytic syndrome (n=1). Pseudothrombocytopenia and neonatal alloimmune thrombocytopenia was considered in two and four patients respectively.

 The reasons of late thrombocytopenia were culture proven sepsis (n=15), clinical sepsis (n=10), necrotizing enterocolitis (n=7), TAR Syndrome (n=1), CMV infection (n=1), and pseudothrombocytopenia (n=5).

Conclusion: In our study we showed that early thrombocytopenia is related to prenatal or natal complications, however late thrombocytopenia is related to late onset infection or necrotizing enterocolitis. In conclusion, the time of onset of thrombocytopenia is important to determine the etiology of thrombocytopenia.

Key Words: Thrombocytopenia, newborn, sepsis

Keywords

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Yenidoğan Yoğun Bakım Ünitemizdeki Erken ve Geç Trombositopeni Nedenlerinin Değerlendirilmesi

Abstract

Amaç: Trombositopeni yenidoğan döneminde sık görülen hematolojik sorunlardan biridir. Bu çalışmanın amacı yenidoğan yoğun bakım ünitemizde (YYBÜ) yatan hastalarda trombositopeni sıklığı ve nedenlerini belirlemektir.

Yöntem: Ocak 2011- Mayıs 2014 tarihleri arasında YYBÜ’de yatan hastalar dosya kayıtlarından geriye yönelik olarak incelendi. Postnatal ilk 72 saatte gözlenen trombositopeni erken, 72 saatten sonra görülenler ise geç trombositopeni olarak tanımlandı. Hastaların demografik ve klinik özellikleri ve laboratuar bulguları kaydedildi.

Bulgular:  Çalışma süresince YYBÜ’ de trombositopeni sıklığı %11 idi.  Erken trombositopeni gözlenen hastaların trombositopeni nedenleri plasental yetmezlik (n=14), 1 hastada aynı zamanda kromozom anomalisi, sepsis (n=14),  maternal trombositopeni (n=7), perinatal asfiksi (n=6), hemofagositoz (n=1)  idi. İki hastada yalancı trombositopeni, 4 hastada tanısal değerlendirme yapılamamakla birlikte, neonatal alloimmün trombositopeni düşünüldü. Geç trombositopeni gözlenen hastaların trombositopeni nedenleri kültür pozitif sepsis (n=15), klinik sepsis (n=10), NEK (n=7),  TAR Sendromu (n=1), CMV enfeksiyonu (n=1) ve yalancı trombositopeni (n=5)  idi.

Sonuç: Çalışmamızda ilk 72 saat içinde tanı alan hastalarda trombositopeni genellikle gebelik veya doğum komplikasyonlarına bağlı iken, 72 saatten sonra tanı alan hastalar sıklıkla edinilmiş enfeksiyon veya nekrotizan enterokolitle ilişkilidir. Sonuç olarak, trombositopeninin erken veya geç olması etiyolojik açıdan önemlidir.  

Keywords

Trombositopeni, yenidoğan, sepsis

References

• Chakravorty S, Roberts I. How I manage neonatal thrombocytopenia. Br J Haematol 2012;156:155–62.
• Roberts I, Stanworth S, Murray NA. Thrombocytopenia in the neonate. Blood Rev 2008;22: 173–86.
• Del Vecchio A. Evaluation and management of thrombocytopenic neonates in the intensive care unit. Early Hum Dev. 2014;90: 51-5.
• Ulusoy E, Tüfekçi O, Duman N, Kumral A, Irken G, Oren H. Thrombocytopenia in neonates: causes and outcomes. Ann Hematol. 2013;92(7):961-7.
• Wiedmeier SE, Henry E, Sola-Visner MC, Christensen RD. Platelet reference ranges for neonates, defined using data from over 47000 patients in a multi hospital health care system. J Perinatol 2009;29: 130–6.
• Van den Hof MC, Nicolaides KH. Platelet count in normal, small, and anemic fetuses. Am J Obstet Gynecol. 1990;162(3):735–9.
• Forestier F, Daffos F, Catherine N, Renard M, Andreux JP. Developmental hematopoiesis in normal human fetal blood. Blood 1991;77: 2360–3.
• Hegyi E, Nakazawa M, Debili N, Navarro S, Katz A, Breton-Gorius J, et al. Developmental changes in human megakaryocyte ploidy. Exp Hematol 1991;19:87-94.
• Murray NA, Watts TL, Roberts IAG. Endogenous thrombopoietin levels and effect of recombinant human thrombopoietin on megakaryocyte precursors in term and premature babies. Pediatr Res 1998;43:148–51.
• Sola MC, Calhoun DA, Hutson AD, Christensen RD. Plasma thrombopoietin concentrations in thrombocytopenic and non-thrombocytopenic neonates in a neonatal intensive care unit. Br J Haematol 1999;104:90–2.
• Murray NA, Roberts IAG. Circulating megakaryocytes and their progenitors in early thrombocytopenia in premature neonates. Pediatr Res 1996;40:112–9.
• Bolat F, Kılıç SÇ, Oflaz MB, Gülhan E, Kaya A, Güven AS, Aygüneş U, Içağasıoğlu D, Gültekin A. The prevalence and outcomes of thrombocytopenia in a neonatal intensive care unit: a three-year report. Pediatr Hematol Oncol 2012;29: 710–20.
• Holzhauer S, Zieger B. Diagnosis and management of neonatal thrombocytopenia. Semin Fetal Neonatal Med 2011;16:305–10.
• Wilejto M, Steele M, Jadavji T. Dropping platelet counts in the neonatal intensive care unit - an unsuspected cause for thrombocytopenia in a neonate. Paediatr Child Health 2011;16: 557 –8.
• Murray NA, Howarth LJ, McCloy MP, Letsky EA, Roberts IA. Platelet transfusion in the management of severe thrombocytopenia in neonatal intensive care unit patients. Transfus Med. 2002;12(1):35-41.
• Stanworth SJ, Clarke P, Watts T, Ballard S, Choo L, Morris T, Murphy MF, Roberts I; Platelets and Neonatal Transfusion Study Group. Prospective, observational study of outcomes in neonates with severe thrombocytopenia. Pediatrics. 2009;124(5):826-34.
• Stanworth SJ. Thrombocytopenia, bleeding, and use of platelet transfusions in sick neonates. Hematology Am Soc Hematol Educ Program. 2012;2012:512-6.
• Celkan T, Toptan HH, Doğru Ö. Yalancı trombositopeni. Türk Ped Arşv 2009;44:73-4.