Evaluation and treatment of severe and prolonged thrombocytopenia in neonates

Sola, Martha C.

doi:10.1016/j.clp.2004.03.014

Cited by 42 publications

(38 citation statements)

References 76 publications

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“…It has been reported that 20% of patients will, at sometime during their NICU stay, receive one or more transfusions. 14,15 That figure is concordant with our present study, where 17% of NICU patients received one or more erythrocyte transfusions during their hospital stay, 4% received one or more platelet transfusions, 6% received FP and 2% received cryoprecipitate. While transfusions in the NICU are relatively common, evidence-based criteria for when to administer them are lacking.…”

Section: Discussionsupporting

confidence: 92%

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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Objective: We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of noncompliance that could be addressed by quality improvement measures. Result: During 2006 the three NICUs cared for 1759 neonates. Seventeen percent of these received one or more (median 3) erythrocyte transfusions, 4% received one or more (median 3) platelet transfusions, 6% received one or more (median 1) FP infusions and 2% received cryoprecipitate (median 1 dose). Seventy percent of the erythrocyte transfusions were given in compliance with the guidelines, as were 69% of the platelet transfusions, 65% of the FP transfusions and 94% of the cryoprecipitate administrations. Patients who received large numbers of transfusions were more likely to receive transfusion that violated the guidelines. Forty-five percent of patients who received 1 to 3 transfusions received all transfusions within guidelines. However, only 18% of patients who received 4 to 10 transfusions received all within guidelines. No patient who received >10 transfusions received all within the guidelines. Erythrocyte transfusions given early in the hospital course were likely to be within guidelines; 72% (588/818) in the first 29 days were compliant with guidelines, but compliance fell to 61% (144/237) for transfusions administered after 29 days (P ¼ 0.002). About half of the platelet transfusions given early in the hospital course were in violation of guidelines, but after day 9, 83% of platelet transfusions were compliant with guidelines (P ¼ 0.000). Conclusion:Opportunities exist in our healthcare system to improve compliance with our transfusion guidelines. Such opportunities are greatest among neonates receiving multiple transfusions, among those receiving erythrocyte transfusions late in their NICU course and among those receiving platelet transfusions early in their NICU course.

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Section: Discussionsupporting

confidence: 92%

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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“…7 However, in a NICU thrombocytopenia is common, with a reported incidence of 18 to 35%. [1][2][3][4][5] On the basis of our experience, we speculated that ELBW neonates have a yet higher incidence of thrombocytopenia. Indeed, in the present study, we observed that 73% of ELBW neonates had one or more platelet counts <150 000/ml.…”

Section: Discussionmentioning

confidence: 99%

“…The magnitude of the hemostatic deficiency created in an ELBW neonate by a count in this range is not known. Neonates who are SGA or were delivered to women with PIH are at an increased risk of developing thrombocytopenia, 3,4,13 and these varieties generally have a nadir count in the range of 50 000 to 100 000/ml. We observed that 55 of 124 ELBW neonates with early recognition (first 3 days of life) thrombocytopenia were thought to have thrombocytopenia on the basis of PIH or SGA.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports estimate that 18 to 35% of all patients admitted to a NICU will have one or more platelet counts p150 000/ml at some time during their NICU stay. [1][2][3][4][5] McPherson and Juul 6 recently observed that the risk of thrombocytopenia in the NICU is highest among the most preterm infants, but we found no previous studies focusing on the incidence, timing, causes, and outcomes of thrombocytopenia among extremely low birth weight (ELBW) neonates.…”

Section: Introductionmentioning

confidence: 93%

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Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

Henry²,

et al. 2006

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Objectives: Thrombocytopenia is common in neonatal intensive care units (NICU), with 18 to 35% of patients developing this problem before hospital discharge. It might be even more common among extremely low birth weight neonates (ELBW, p1000 g birth weight). However, little is known about thrombocytopenia in the ELBW population. We sought to determine the incidence, timing, causes, platelet transfusions given, and outcomes of thrombocytopenia among ELBW neonates. Results: Multiple platelet counts were obtained in all 284 (range, 4 to 441 platelet counts/patient). Of the 284, 208 (73%) had one or more platelet counts p150 000/ml. Most were detected during the first days of life; 80% were detected during the first week and only 20% were detected thereafter. Thrombcytopenia was more common among the smallest patients; 85% incidence among those p800 g, 60% among those 801 to 900 g, and 53% among those 901 to 1000 g. Platelet transfusions were given to 129 of the 208 thrombocytopenic neonates. More than 90% were given prophylactically (the patient was not bleeding). The mortality rate among those that received platelet transfusions was twice that of those that received no platelet transfusions (P<0.01). In 48% of cases, the cause of the thrombocytopenia went undiagnosed. The most common explanations were being small for gestational age or delivered to a hypertensive mother, DIC, bacterial infection, fungal infection, and necrotizing enterocolitis, respectively. Conclusions:We observed thrombocytopenia among ELBW neonates at a rate more than twice that reported among the general NICU population. Much remains to be discovered about the etiology and best treatments of thrombocytopenia among ELBW neonates.

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“…1,2 Likewise, an abnormally high concentration of platelets (thrombocytosis) can indicate the presence of a disorder. [3][4][5][6] Therefore, measuring the concentration of platelets in the blood can be useful in neonatal medicine.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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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 .

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Evaluation and treatment of severe and prolonged thrombocytopenia in neonates

Cited by 42 publications

References 76 publications

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

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

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