Thrombocytopenia and retinopathy of prematurity

Abstract

Background Platelets may act as vascular endothelial growth factor (VEGF) scavengers, possibly limiting neovascularization in retinopathy of prematurity (ROP). The purpose of this study was to investigate the association between thrombocytopenia (platelets <150,000/μL) and the development of type 1 ROP. Methods This was a retrospective 1:1 matched case-control study. Cases required laser; controls developed no or stage 1 ROP and were matched for birth weight within 100 g and gestational age within 1 week. Most recent platelet count prior to laser (case) and matched postmenstrual age (control) were abstracted. Conditional logistic regression was used. Results A total of 91 cases and 91 controls were reviewed. Of the cases, 25% had thrombocytopenia; of controls, 13% (P = 0.034; OR = 2.38; 95% CI, 1.04-5.43). Birth weight, gestational age, postmenstrual age, and culture-proven sepsis were not confounders in multivariate analysis. The association was significant for zone 1 (n = 16; OR = 9.00; 95% CI, 1.14-71.0) but not for zone 2 (OR = 1.43; 95% CI, 0.54-3.75) cases and controls. Conclusions Thrombocytopenia was associated with type 1 ROP, primarily among infants with zone 1 ROP. This effect may result from disease location or disease timing, as posterior disease occurs at an earlier postmenstrual age. Longitudinal studies are required to further examine the roles of cumulative platelet deficits, thresholds, or critical time windows in the observed association.

Relationship between mean platelet volume and retinopathy of prematurity

“…The authors suggested that thrombocytopenia (platelet count of < 100,000/mm 3 ) was associated with severe posterior retinopathy as well. In agreement with this finding, Jensen et al found that thrombocytopenia was associated with type 1 ROP, primarily among infants with zone 1 ROP [16]. This led us to investigate a biological explanation for the interesting phenomena.…”

“…Thus, consistent with the present study, the platelets will become larger, and the relative elevated MPV values will be noticed. For the infants who develop ROP with thrombocytopenia, the serum platelet deficit may contribute to the lack of function of either delivering the optimal level or incompletely scavenging the excess of VEGF in the immature retina [15,16]. This may accelerate the occurrence or development of ROP.…”

Reduction in screening for retinopathy of prematurity through risk factor adjusted inclusion criteria

“…Treatment with dopamine was a risk factor for (severe) ROP in studies of Mizoguchi et al and Liu et al 12 13 Hoogerwerf et al , Smolking et al and the systematic review of the Cochrane database showed that (late) treatment with postnatal steroids is a risk factor for ROP 6 14 15. Lee, Chen et al , Weintraub et al and Jensen et al demonstrated perinatal infection/inflammation or sepsis to be a risk factor for (severe) ROP 16 – 19. Arrøe proved this for NEC 20…”

Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia

“…Case reports and clinical experience suggests that APROP develops in infants with the worst health status; however, to our knowledge, only sepsis is identified as a significant risk factor for APROP [9]. Some studies suggest that low platelet counts/thrombocytopenia could be associated with APROP and that platelet transfusion might be a potential new ROP treatment strategy [10,11]. In Sweden, data on all infants screened for ROP are registered in SWEDROP, a national quality register with a 96% national coverage [7].…”