Trombocitopenia neonatal: Revisión. I. Definiciones, diagnóstico diferencial, causas, trombocitopenias inmunes / Neonatal thrombocytopenia: A review. I. Definitions, differential diagnosis, causes, immune thrombocytopenia

La trombocitopenia, definida como recuento plaquetario inferior a 100 x 109/l, es un hallazgo muy frecuente en el período neonatal, que ocurre, en especial, en niños críticamente enfermos y en prematuros. Sus causas son múltiples: puede deberse tanto a enfermedades del niño como a otros factores involucrados en la interrelación niño-placenta-madre. En este primer artículo, se enumeran las causas de trombocitopenia; se plantea el enfoque diagnóstico frente a un neonato trombocitopénico y se describen detalladamente las distintas entidades correspondientes a trombocitopenias de etiología inmune. Se presentan los diferentes mecanismos causales y se revisan las distintas características de la trombocitopenia secundaria a trombocitopenia inmune materna y de la trombocitopenia neonatal aloinmune. Se describen las diversas estrategias terapéuticas disponibles para cada una de ellas, tanto para su manejo posnatal como para el prenatal. Se enfatiza sobre la gravedad de la enfermedad y las serias complicaciones y secuelas asociadas a la trombocitopenia neonatal aloinmune

Thrombocytopenia, defined as a platelet count below 100 x 109/L, is a very common finding in the neonatal period, especially in critically ill infants and preterm newborns. Its causes are multiple: it may be due both to pediatric conditions and to other factors involved in the fetal-placental-maternal interface. This initial article describes the causes of thrombocytopenia, proposes a diagnostic approach to manage a thrombocytopenic newborn infant, and provides a detailed description of the different conditions corresponding to thrombocytopenia of immune etiology. It also describes the different causative mechanisms and reviews the varying characteristics of thrombocytopenia secondary to maternal immune thrombocytopenia and neonatal alloimmune thrombocytopenia. The different treatment approaches to each of the different conditions are described both for their pre- as well as their postnatal management. The severity of thrombocytopenia and the serious complications and sequelae associated with the neonatal alloimmune thrombocytopenia are highlighted.

The influences of mothers with moderate and severe gestational thrombocytopenia and primary immune thrombocytopenia on neonates / 中国新生儿科杂志

Objective:To study the effects of maternal moderate and severe gestational thrombocytopenia (GT) and primary immune thrombocytopenia (ITP) on neonates.Method:From Jan 2018 to Dec 2019, pregnant women with platelet count <100×10 9/L during pregnancy admitted to our hospital were retrospectively reviewed. The infants were assigned into GT group and ITP group according to their mothers' diagnoses. The clinical outcomes were compared between the two groups. Result:Of 104 mothers with platelet count <100×10 9/L, 32 (30.8%) were diagnosed with ITP and 72 (69.2%) with GT. Gestational age (GA) of the ITP group was smaller than the GT group [(37.0±1.5) weeks vs. (38.0±2.0) weeks, P<0.05]. The maternal platelet count within 24 h before delivery (39×10 9/L vs. 86×10 9/L) and the lowest platelet count during pregnancy (17×10 9/L vs. 75×10 9/L) in the ITP group were both lower than the GT group, the differences were statistically significant ( P<0.001). The maternal platelet count after birth in ITP group were lower than the GT group (184×10 9/L vs. 277×10 9/L, P<0.01). Neonates in the ITP group have an increased tendency to develop neonatal thrombocytopenia (NT) than the GT group (43.8% vs. 6.9%, P<0.001). The platelet count on the first day after birth (92×10 9/L vs. 170×10 9/L) and the lowest platelet count (43×10 9/L vs. 103×10 9/L) of NT newborns in the ITP group were lower than the GT group ( P<0.05). No differences existed for the time needed reaching the lowest platelet count in NT newborns between the two groups [(3.5±1.2) d vs. (4.4±0.4) d, P>0.05]. Neither group had intracranial hemorrhage. Conclusion:Neonates born to pregnant mother with platelet count <100×10 9/L have a tendency to develop NT. The incidence of NT in neonates born to mothers with ITP is higher than GT, but the overall prognosis of the newborns is good.

Study of changes noted in the platelet count in cord blood of neonates born to hypertensive mothers in a tertiary care hospital, Bangalore, India

Background: Hypertensive disorders of pregnancy pose several problems to both mother and newborn. Complications in new-born like intrauterine death (IUD), intrauterine growth retardation (IUGR), perinatal asphyxia, neonatal sepsis and bleeding disorders are associated with toxemia of pregnancy. To decrease the perinatal morbidity and mortality, babies of hypertensive mothers should be carefully monitored and managed. Aim of this study was to establish the changes in total platelet count in umbilical cord blood.Methods: This is a hospital based prospective observational study which included the babies born to mothers having hypertensive disorders of pregnancy, total cases accounting about 158. Detailed clinical history taken including details of labour and clinical examination done.' In all the subjects, 2 ml of umbilical cord blood anticoagulated with EDTA was collected and haematological tests for total platelet count (TPC) count was done.Results: This study shows that the incidence of neonatal thrombocytopenia is 43.67%. The incidence of sepsis among thrombocytopenia group accounts for about 60% in gestational hypertension, 64.2% in pre-eclampsia and 50% in eclampsia group.Conclusions: With respectively, these findings it can be concluded that the incidence of Neonatal Thrombocytopenia is significantly higher in babies born to HDP mothers and it can be taken as a marker to evaluate Sepsis in such a situation in resource limited setting. As less number of studies is available in this area of interest, this study supports the cause.

Clinical profile and outcome of neonatal thrombocytopenia in a tertiary care hospital

Background: Thrombocytopenia (platelet count <1,50,000/'L) is one of the most common haematological problems in neonatal intensive care units. In contrast, only 2% of the normal neonates are thrombocytopenic at birth with severe thrombocytopenia (platelet count <50,000/'L) occurring in less than 3/1000 term infants. Multiple disease processes can cause thrombocytopenia in neonates. The important causes of thrombocytopenia in neonates are sepsis, birth asphyxia, prematurity, intra-uterine growth retardation, hyperbilirubinemia, respiratory distress syndrome, meconium aspiration syndrome and low birth weight. Apart from platelet count, bleeding manifestations depend on underlying ailments. The aims and objective were to study the clinical profile, etiology and outcome of neonatal thrombocytopenia in a tertiary care hospital.Methods: Prospective study involving 100 neonates with or developed neonatal thrombocytopenia in NICU.Results: In present study, 100 new-borns with thrombocytopenia 46% were mild, 35% were moderate and 19% were severe thrombocytopenia. 51 (51%) had early onset neonatal thrombocytopenia and 49 (49%) babies had late onset neonatal thrombocytopenia. Anaemia was the dominant maternal predisposing risk factor. Sepsis was the most common cause of neonatal thrombocytopenia. Most common symptom was apnoea. Sepsis, RDS and NEC had significantly contributed to mortality. Most common cause of death was sepsis followed by RDS and NEC.Conclusions: Neonatal thrombocytopenia is a treatable and reversible condition. Hence, it is important to identify neonates at risk and initiate transfusion therapy to prevent severe bleeding and potentially significant morbidity. Anaemia and PROM were the commonest maternal risk factors. Therefore, author recommended that babies born to mothers with these risk factors should be closely monitored for thrombocytopenia.

Isolated thrombocytopenia in childhood: what if it is not immune thrombocytopenia?

<p><b>INTRODUCTION</b>Childhood immune thrombocytopenia (ITP) remains a diagnosis of exclusion when isolated thrombocytopenia is not part of another disease process. In practice, the diagnosis of ITP can only be confirmed when thrombocytopenia resolves or is excluded after the recognition of a primary cause.</p><p><b>METHODS</b>The records of 87 consecutive children with isolated thrombocytopenia seen over a nine-year period in a private paediatric haematology practice were reviewed retrospectively. Children in whom a primary cause was eventually found were the subjects of a further descriptive study.</p><p><b>RESULTS</b>9 (10%) children with isolated thrombocytopenia were not diagnosed with ITP because a primary disease was found. Of these nine cases, four had thrombocytopenia recognised during the neonatal period, consisting of perinatal cytomegalovirus infection (n = 2), meconium aspiration pneumonia (n = 1) and transient abnormal myelopoiesis associated with Down syndrome (n = 1). The remaining five children were each found to have familial thrombocytopenia, portal hypertension, cutaneous mastocytosis, May-Hegglin anomaly and systemic lupus erythematosus. Two of them had a history of failure of response to corticosteroid therapy.</p><p><b>CONCLUSION</b>Secondary thrombocytopenia is not uncommon in a tertiary paediatric specialty practice with adequate evaluation. Thrombocytopenia occurring during the newborn period and failure of steroid therapy are predictive of secondary cases.</p>

Can we predict neonatal thrombocytopenia in offspring of women with idiopathic thrombocytopenic purpura?

BACKGROUND: We aimed to investigate which factors in the clinical profile of mothers with idiopathic thrombocytopenic purpura (ITP) can predict neonatal risk of thrombocytopenia. METHODS: Data was retrospectively collected from all pregnant women with ITP who presented to our institution between 2001 and 2013. Neonatal offspring of these women were classified into 2 groups based on the presence or absence of neonatal thrombocytopenia (platelet count <100x109/L). Several parameters were compared between the 2 groups, including maternal age, maternal platelet count, maternal treatment history, and thrombocytopenia in siblings. We further examined the correlation between maternal platelet count at the time of delivery and neonatal platelet count at birth; we also examined the correlation between the minimum platelet counts of other children born to multiparous women. RESULTS: Sixty-six neonates from 49 mothers were enrolled in the study. Thrombocytopenia was observed in 13 (19.7%) neonates. Maternal treatment for ITP such as splenectomy did not correlate with a risk of neonatal thrombocytopenia. Sibling thrombocytopenia was more frequently observed in neonates with thrombocytopenia than in those without (7/13 vs. 4/53, P<0.01). No association was observed between maternal and neonatal platelet counts. However, the nadir neonatal platelet counts of first- and second-born siblings were highly correlated (r=0.87). CONCLUSION: Thrombocytopenia in neonates of women with ITP cannot be predicted by maternal treatment history or platelet count. However, the presence of an older sibling with neonatal thrombocytopenia is a reliable risk factor for neonatal thrombocytopenia in subsequent pregnancies.

Maternal and neonatal outcomes in pregnancies complicated with idiopathic thrombocytopenic purpura (ITP) / 대한산부인과학회지

OBJECTIVE: To investigate the maternal and neonatal outcomes in pregnancies complicated with idiopathic thrombocypenic purpura (ITP) and to identify antenatal factors to predict the neonatal thrombocytopenia. METHODS: We analyzed retrospectively maternal and neonatal outcomes of the32 pregnant women with ITP who were delivered over a 12-year period. RESULTS: The prevalence incidence of ITP in pregnancy was 0.87 per 1,000 live births in this study population. The diagnosis of ITP was made more before pregnancy than with afterduring during pregnancy (63% vs 37%). Maternal platelet transfusion was done in 62.5 % of pregnancies with ITP. Sixty nine percent of pregnancies with ITP received medical therapies; steroid only in 8 cases (25%), steroid + IVIG (intravenous immunoglobulin) in 6 cases (18.7%), IVIG only in 2 cases (6.2%), and steroid + IVIG + anti-Rh (anti-D) in 1 case (3.1%). Overall response rate (Plt > 50 x 10(9)/L) to medical treatment was 77%. Neonatal thrombocytopenia (Plt < 50 x 10(9)/Ll) was observed seen in 4 cases (14.2%) immunoglobulin. There was no correlation between the maternal and the neonatal platelet count. Moreover medical treatment during pregnancy did not make any difference in neonatal platelet count. There was one case of neonatal ICH (germinal matrix hemorrhage). CONCLUSION: Although neonatal thrombocytopenia occurred in 140% of pregnancies with ITP, no antenatal factor could predict neonatal thrombocytopenia.

Differential diagnosis of Thrombocytopenia newly developed during pregnancy / 대한산부인과학회지

OBJECTIVE: Gestational thrombocytopenia has a mild course as a common problem during pregnancy, whereas idiopathic thrombocytopenic purpura (ITP) presents with a chronic or moderate to severe course. Very few studies have been conducted so far to discriminate between the two diseases. This study was aimed to identify factors predictive of the subsequent development of ITP among pregnant women presenting with thrombocytopenia. METHODS: From January 1999 to June 2005, a total of 58 pregnant women newly diagnosed with thrombocytopenia were recruited for the study. Among them, 33 were finally diagnosed with gestational thrombocytopenia and the other 25 with ITP. The clinical factors for each of ITP and neonatal thrombocytopenia were evaluated, and final outcomes were also described. RESULTS: On multivariate analysis, thrombocytopenia diagnosed before 28 completed weeks and platelet count of less then 50 x 10(9)/L at the time of its presentation were found to be independently predictive of ITP (p<0.001 and p=0.004 respectively). In addition, platelet count of less then 20 x 10(9)/L at nadir during pregnancy was a significant risk factor for neonatal thrombocytopenia (p=0.013). CONCLUSION: The onset time of thrombocytopenia and platelet count at its presentation remain useful parameters to discriminate ITP from gestational thrombocytopenia. These findings may help in allowing an appropriate antenatal care and postpartum follow up.

The Outcome of Pregnancy Combined with Idiopathic Thrombocytopenia Purpura and the Effect of Pregnancy on the Severity of This Disease / 대한주산의학회잡지

OBJECTIVE: The incidence of idiopathic thrombocytopenic purpura (ITP) is greatest in female during their childbearing years, so the concurrence of pregnancy and ITP is not unusual. Numerous studies have examined the outcomes of newborns, whereas fewer studies have been conducted with regard to the morbidity of obstetric patients with ITP. This study was aimed to find the outcome of pregnancy combined with ITP and the influence of the pregnancy on the severity of this disease. METHODS: From January 1996 to December 2005, a total of 62 pregnant women with ITP and their 73 deliveries were recruited for the study. Among them, 38 were diagnosed with ITP during pregnancy and the other 24 had pre-existing ITP before pregnancy. RESULTS: The severity of thrombocytopenia was exacerbated during pregnancy, but recovered to a level of non-pregnant period after delivery in most cases. The outcome of pregnancy of all the patients was uneventful except each one case of fetal demise at 35 gestational weeks and preterm delivery at 30 gestational weeks. One patient suffered from multiple subdural hemorrhage during pregnancy, which was spontaneouly recovered. Twenty newborns (27.8%) had transient congenital thrombocytopenia and 18 of them required treatment for hemostatic impairment. CONCLUSION: For women with ITP, Pregnancy can affect the severity of ITP, but life-threatening complication was almost lacking. Although, in not a few cases, there may need to treat both mothers and infants to raise their platelet counts, most mothers with ITP can proceed with their pregnancies and delivery healthy infant without complication.

Hematologic Characteristics of Neonates Born to Pregnancy-Induced Hypertensive Mothers

PURPOSE: To determine clinical and hematological characteristics of infants born to pregnancy-induced hypertensive mothers and whether neutropenia in these infants is associated with an increased incidence of neonatal sepsis. METHODS: A retrospective study was conducted from June 1995 to June 1997 in 84 infants of pregnancy-induced hypertensive mothers who were admitted to the neonatal intensive care unit of Asan Medical Center. These infants were divided into 2 groups according to their absolute neutrophil counts(Group I: with neutropenia, Group II: without neutropenia) and their clinical, hematological and maternal characteristics were compared between these groups. RESULTS: 1) Infants in Group I were smaller, younger, and delivered more by cesarean section than in infants in Group II. 2) Neutropenia was observed in 77,7% of infants who were less than 30 weeks of gestational age and less than 1,500 g. Neutropenia and thrombocytopenia seem to be a transient phenomenon improving spontaneously approximately after 5.8 days and 8-10 days, respectively. 3) Sex, 1 min apgar score, type of delivery and initial use of antibiotics differ between these 2 groups. 4) There was no apparent increased risk for development of neonatal sepsis associated with neutropenia. CONCLUSION: Neutropenia and thrombocytopenia were observed in 40-50% infants born to pregnancy-induced hypertensive mothers. Such finding was more pronounced in infants whose gestational age was less than 32 weeks and birth weight was less than 1,500 g occuring at 70-80%. Neutropenia, per se, is not associated with increased incidence of sepsis but changes in hematological findings and clinical evidence is more important in predicting sepsis in these infants.