Neonatal thrombocytopenia: etiology, management and outcome

Abstract

Thrombocytopenia is a very common hematological abnormality found in newborns, especially in preterm neonates. Two subgroups can be distinguished: early thrombocytopenia, occurring within the first 72 hours of life, and late thrombocytopenia, occurring after the first 72 hours of life. Early thrombocytopenia is associated with intrauterine growth restriction, whereas late thrombocytopenia is caused mainly by sepsis and necrotizing enterocolitis (NEC). Platelet transfusions are the hallmark of the treatment of neonatal thrombocytopenia. Most of these transfusions are prophylactic, which means they are given in the absence of bleeding. However, the efficacy of these transfusions in preventing bleeding has never been proven. In addition, risks of platelet transfusion seem to be more pronounced in preterm neonates. Because of lack of data, platelet transfusion guidelines differ widely between countries. This review summarizes the current understanding of etiology and management of neonatal thrombocytopenia.

Keywords::

• platelet transfusion
• premature infant
• thrombocytopenia

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Thrombocytopenia occurs often in newborns, especially those admitted to neonatal intensive care units.

• Early thrombocytopenia (occurring <72 h after birth) is associated with intrauterine growth restriction. The main causes of late thrombocytopenia (occurring >72 h after birth) are sepsis and necrotizing enterocolitis.

• A causal relationship between thrombocytopenia and bleeding has never been demonstrated.

• The majority of neonates with severe thrombocytopenia receive prophylactic platelet transfusions, but the effect of these platelet transfusions on preventing major bleeding has not been proven and transfusions are associated with risks.

• We urgently need evidence on the indication and dose of prophylactic platelet transfusion in neonatal thrombocytopenia.