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Neonatal thrombocy/openia: what you need to know Enrico Lopriore Leiden University Medical Center Regionale Neonatologie 2013 Thrombocytopenia Take home messages incidence Frequent disorder e5ology Multiple causes ( production; loss) diagnosis Classification: early vs late onset (72h) therapy PLT transfusion (benefit??) prognosis Increased risk of bleeding (threshold??) Regionale Neonatologie 2013 De1inition Platelets < 150 x 109/L P l a t e>l e 1t s5 01s tx t1r0i m9 /eLs t e r Mild: 100-‐149 x 109/L Moderate: 50-‐99 x 109/L Severe: 20-‐49 x 109/L Very severe: < 20 x 109/L <V 3e0r y x s 1e0v9e/rLe? ? Regionale Neonatologie 2013 Incidence 1-‐5% of all neonates 20-‐35% of NICU admissions < 50 x 109/L: 5-‐10% of NICU admissions platelet transfusions: 2-‐15% S i m i l a r N I C U p o p u l a 5 o n s Regionale Neonatologie 2013 Causes Fetal Alloimmune (FNAITP) Autoimmune (ITP/SLE) Aneuploidy (trisomy 13, 18, 21) Congenital TORCH infection Rhesus alloimmunization Congenital/inherited (Wiskott-‐Aldrich) Regionale Neonatologie 2013 Causes < late onset > 72h early onset 72h Placenta-‐insufficiency Late-‐onset sepsis (IUGR/diabetes) Perinatal asphyxia Necrotizing enterocolitis Perinatal infection Thrombosis (GBS, E Coli) (catheter/renal vein) Congenital TORCH infection Kasabach-‐Merritt syndrome Polycythemia Metabolic disease (proprionic acidemia, CDG) Alloimmune Congenital/inherited (FNAITP) (TAR, CAMT) Autoimmune (ITP/SLE) Rhesus alloimmunization Regionale Neonatologie 2013 Causes < late onset > 72h early onset 72h Placenta-‐insufficiency Late-‐onset sepsis (IUGR/diabetes) Perinatal asphyxia Necrotizing enterocolitis Perinatal infection Thrombosis (GBS, E Coli) (catheter/renal vein) Congenital TORCH infection Kasabach-‐Merritt syndrome Polycythemia Metabolic disease (proprionic acidemia, CDG) Alloimmune Congenital/inherited (FNAITP) (TAR, CAMT) Autoimmune (ITP/SLE) Rhesus alloimmunization Regionale Neonatologie 2013 Thrombocytopenia & IUGR Mechanism? Chronic hypoxia + leucocytopenia ↑ Thrombocytopenia EPO ↓ ↑ megakaryo-‐ Erythroblastos cytopoiesis is Regionale Neonatologie 2013 Thrombocytopenia & IUGR Case-‐control study LUMC SGA < p10 AGA n=330 n=330 Gesta0onal age at birth – wks 32.9 ± 4.0 32.9 ± 4.0 Birth weight – gr 1428 ± 657 2152 ± 964 Maternal hypertension – n (%) 127 (38%) 82 (25%) Cesarean delivery – n (%) 208 (63%) 124 (38%) Female – n (%) 152 (46%) 169 (51%) Regionale Neonatologie 2013 Thrombocytopenia & IUGR Results SGA < p10 AGA OR p-‐value n=330 n=330 Early-‐onset thrombocytopenia < 150 45% 15% 4.5 < 0.01 Early-‐onset thrombocytopenia < 50 8% 0.3 % 22.3 < 0.01 Platelets transfusion – n (%) 3% 0.3 % 11.3 0.04 Erytroblastosis – n (%) 42% 10% 6.5 < 0.01 Leucocytopenia – n (%) 21% 6% 3.9 < 0.01 Regionale Neonatologie 2013

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IEA. IgG against platelet Ag. Fetal/Neonatal AlloImmune Thrombocytopenia. Mechanism. 80% HPA-‐1a 15% HPA-‐5b

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IEA. IgG against platelet Ag. Fetal/Neonatal AlloImmune Thrombocytopenia. Mechanism. 80% HPA-‐1a 15% HPA-‐5b

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Publication Year:	2013
Pages:	24
Language:	English
File Size:	1.79
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