Late-onset Thrombocytopenia Research Articles

Clinical Characteristics and Risk Factors for Persistent Thrombocytopenia among Pediatric Patients after Bone Marrow Transplant in Saudi Arabia: A 3-Year Retrospective Observational Analysis from Tertiary Hospital

Background Bone marrow transplantation (BMT) is a crucial treatment for pediatric patients with various hematological, oncological, and genetic diseases. However, persistent thrombocytopenia (PT) post-transplantation poses a significant challenge, affecting recovery and prognosis. Purpose This study aimed to identify the clinical characteristics and risk factors associated with PT in pediatric patients post-BMT, specifically in Saudi Arabia. Methods A retrospective cohort study design was employed, involving pediatric patients who underwent BMT between January 2020 and January 2023. Clinical characteristics, laboratory results, treatment data, and outcomes were collected from electronic medical records. Logistic regression analyses were conducted to identify risk factors associated with PT. Results Among the 77 pediatric patients in the study, no significant differences were observed in demographic characteristics, transplant types, or treatment modalities between early-onset and late-onset thrombocytopenia groups. However, the duration of thrombocytopenia post-transplant differed significantly between the groups, with early-onset cases experiencing shorter durations. Infections and graft-versus-host disease were common post-transplant complications. Chemotherapy and antiviral therapy were frequently administered treatments. Pediatric patients undergoing BMT are susceptible to PT, with varying durations based on the onset timing. Conclusion The study emphasizes the importance of risk assessment and tailored management to mitigate thrombocytopenia in pediatric BMT patients. Further research is needed to elucidate the underlying mechanisms and optimize therapeutic interventions for thrombocytopenia in this population.

Immune Thrombocytopenia Following Dengue Fever

Introduction: Dengue is an endemic mosquito-borne infection in tropical countries. The manifestations vary from asymptomatic infection to classic dengue fever, to more critical forms like dengue hemorrhagic fever and dengue shock syndrome. The critical phase occurs typically within the timeline of 4-7 days from the onset of symptoms. Case Report: We, hereby, report the case of a 7-year-old girl child who initially recovered from classic dengue fever. However, she was readmitted 18 days after the onset of initial symptoms with major bleeding manifestations due to immune thrombocytopenia responding to intravenous immunoglobulin. Discussion: Dengue fever may be associated with mild to moderate thrombocytopenia in the febrile phase and moderate to severe thrombocytopenia in the critical phase. Here, the index case developed thrombocytopenia much after the expected critical phase was over. Conclusion: Awareness of this possibility and continued monitoring, even after apparent recovery from dengue, is important for detecting and managing late-onset thrombocytopenia.

Thrombocytopenia-related outcome and pattern in preterm neonates hospitalized in neonatology unit: A single-center experience

Abstract: BACKGROUNDS: In preterm newborns, thrombocytopenia is one of the most often observed hematologic findings. Most cases of thrombocytopenia are mild to moderate, self-limiting, and have a short duration; nevertheless, in rare cases, it can result in serious complications including pulmonary hemorrhage that lead to death and morbidity. OBJECTIVES: The objective of this study was to identify the pattern, risk factors, and outcome of thrombocytopenia in preterm neonates hospitalized in a tertiary-level neonatal intensive care unit (NICU). PATIENTS AND METHODS: All sick preterm neonates who developed thrombocytopenia within the first 28 days of life admitted to the NICU were included. A platelet count was performed at presentation time and as needed after that. Thrombocytopenia-related morbidities (intraventricular hemorrhage, pulmonary hemorrhage, and sepsis), mortality, and risk factors were analyzed concerning severity (mild, moderate, and severe) and age of thrombocytopenia onset (early and late) in preterm neonates. RESULTS: A total of 100 preterm neonates were admitted to our NICU. Of these, 48% of neonates developed thrombocytopenia. In terms of severity, mild, moderate, and severe thrombocytopenia were present in 62.5%, 37.5%, and 16.7% of newborns, respectively. The prevalent risk factors for late-onset thrombocytopenia (LOT) were necrotizing enterocolitis (NEC) and late-onset sepsis; for early-onset thrombocytopenia, the risk factors were pregnancy-induced hypertension and early-onset sepsis. Neonates with sepsis, severe birth asphyxia, and NEC were significantly associated with severe thrombocytopenia (P < 0.001). Thrombocytopenia-related morbidities and mortality were significantly higher among moderate-to-severe thrombocytopenia cases (P < 0.001). CONCLUSIONS: Sepsis was the most common risk factor associated with severe and LOT. Compared to mild/moderate thrombocytopenia, severe thrombocytopenia required more platelet transfusions, was associated with major bleeding manifestations, and had a higher mortality rate. When caring for premature newborns, these issues need to be taken into account.

Thrombocytopenia and clinical outcomes among patients with COVID-19 disease: A cohort study.

Thrombocytopenia is increasingly recognized among patients with critical illness and plays a role in several diseases affecting different organ systems. Therefore, we studied the prevalence of thrombocytopenia among hospitalized COVID-19 patients and its correlation with disease severity and clinical outcomes. This was an observational retrospective cohort study conducted on 256 hospitalized COVID-19 patients. Thrombocytopenia is defined as a platelet count below 150,000/μL. Disease severity was classified based on the five-point CXR scoring tool. Thrombocytopenia was found in 66 (25.78%) patients. In outcomes, 41 (16%) patients were admitted to intensive care unit, 51 (19.9%) died, and 50 (19.5%) had acute kidney injury (AKI). Of the total patients with thrombocytopenia, 58 (87.9%) had early thrombocytopenia, while 8 (12.1%) had late thrombocytopenia. Notably, mean survival time was markedly decreased in late-onset thrombocytopenia cases (p < 0.0001). Patients with thrombocytopenia showed a significant increase in creatinine compared to those with normal platelet counts (p < 0.05). Moreover, thrombocytopenia was more prevalent in patients with chronic kidney disease compared to other comorbidities (p < 0.05). In addition, hemoglobin was significantly lower in the thrombocytopenia group (p < 0.05). Thrombocytopenia is a common finding among COVID-19 patients, with a predilection toward a specific group of patients, though the exact reasons are unclear. It predicts poor clinical outcomes and is closely linked to mortality, AKI, and the need for mechanical ventilation. These findings suggest that more research is required to study the mechanism of thrombocytopenia and the possibility of thrombotic microangiopathy in COVID-19 patients.

Severe autoimmune thrombocytopenia in a neonate secondary to maternal immune thrombocytopenia: a case report

&lt;p&gt;Neonatal thrombocytopenia is one of the common haematological problems encountered in neonatal intensive care unit. Severe neonatal thrombocytopenia is defined as a platelet count &amp;lt;50×10&lt;sup&gt;3&lt;/sup&gt;/µl and is relatively uncommon. Based on the time-of-onset, neonatal thrombocytopenia can be categorized into early-onset (&amp;lt;72 h after birth) and late-onset (&amp;gt;72 h after birth) thrombocytopenia. Neonatal autoimmune thrombocytopenia should be considered in any neonate who has early-onset thrombocytopenia and a maternal history of either immune thrombocytopenia (ITP) or an autoimmune disease (with or without thrombocytopenia). A term male baby, born to a 23-year-old primi-gravida with ITP was found to be thrombocytopenic at birth (platelets-85×10&lt;sup&gt;3&lt;/sup&gt;/µl) without any sign of neonatal sepsis. On serial monitoring, platelet counts kept falling and on day 3, the child developed severe thrombocytopenia (platelets-6.5×10&lt;sup&gt;3&lt;/sup&gt;/µl). No obvious signs of bleeding were present and the child was clinically well. Given the history of maternal thrombocytopenia (likely ITP), a possibility of neonatal autoimmune thrombocytopenia was considered. Owing to the risk of massive bleed, the baby was transfused random donor platelets and intravenous immunoglobulin (IVIg) was started on day 3. Thereafter, the platelets showed an increasing trend and child was discharged on day 7 with a platelet count of 170×10&lt;sup&gt;3&lt;/sup&gt;/µl. However, on follow-up platelet count was again found to be low (84×10&lt;sup&gt;3&lt;/sup&gt;/µl). It normalised subsequently, without any further requirement of IVIg. High index of suspicion, immediate work-up and diagnosis, with close monitoring and prompt management is required to prevent hemorrhagic complications in such children. Counselling for risk of thrombocytopenia in future pregnancies should be provided to parents.&lt;/p&gt;

Incidence and Risk Factors of Thrombocytopenia in Neonates Admitted with Surgical Disorders to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital: A One-Year Observational Prospective Cohort Study from a Low-Income Country.

BackgroundThrombocytopenia is one of the most common hematologic disorders affecting neonates admitted to the neonatal intensive care unit. The aim of this study was to determine the incidence and associated risk factors of neonatal thrombocytopenia in neonates admitted with surgical disorders.MethodsAn observational prospective cohort study was conducted and all neonates admitted to neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders were included. Data were collected using a checklist and analyzed by SPSS version 23. Chi square test and independent sample t- test were used to assess the association among different variables.ResultsA total of 210 neonates were included in the study, out of which 56.2% were males. The incidence of thrombocytopenia was 55.8%. Among neonates with thrombocytopenia, 90.9% had late onset thrombocytopenia and half were in the severe range (<50,000/µL). The presence of sepsis (P = 0.000) and atresia (P = 0.000) were found to be significantly associated with the development of thrombocytopenia. The mean non feeding hours were found to be significantly longer for patients with thrombocytopenia (t [199], 5.81, P = 0.000).ConclusionThe incidence of thrombocytopenia is high in our institution. Prevention methods towards neonatal sepsis should be given due emphasis.

PREVALENCE AND OUTCOME OF THROMBOCYTOPENIA AND ITS CORRELATION WITH CRP IN NEONATAL INTENSIVE CARE UNIT

Introduction: Neonatal thrombocytopenia, one of the most common hematological abnormalities in neonates particularly in premature and sick neonates. The aim of this study to study the prevalence and outcome of Thrombocytopenia and its correlation with CRP in the neonatal intensive care unit. Objectives: 1. To nd the prevalence of Thrombocytopenia in the Neonatal intensive care unit in King George Hospital. 2. Factors that predisposing to Thrombocytopenia in neonates 3. Outcomes of thrombocytopenia in neonates. 4. Correlation of thrombocytopenia with the C-reactive protein (CRP) in neonates. Materials And Methods: It is a cross -sectional study in 80 Newborns less than or equal to 28 days admitted in NICU, king George hospital, Visakhapatnam from JANUARY 2019 to JUNE 2020 over period of 18 months. Data is collected from the medical records. Results: The prevalence of thrombocytopenia in this study is 40% with early-onset thrombocytopenia being 65% whereas, that of late-onset thrombocytopenia is 35% ,strong assosciation is found between thrombocytopenia and sepsis ,with mild to moderate variety being (86.4%) and (40%) of severe thrombocytopenia group. Of 80 newborns ,90% of severely thrombocytopenic group have positive CRP, whereas it is 40.9% in the mild to moderate group and 1.4% in normal group.40% of severe thrombocytopenic group had elevated PT, APTT, INR. There was higher proportion of bleeding (45.5%) in severe thrombocytopenia group. gastrointestinal bleeding constituted for 36.4% and intracranial bleeding 2.1% . Conclusion: Positive septic workup is signicantly association with thrombocytopenia, CRP was signicantly association with thrombocytopenia in this study

English

BACKGROUND Neonatal thrombocytopenia is one of the most common haematological abnormalities in neonates occurring in 1 to 2 % of healthy term neonates. Various risk factors like sepsis, prematurity, and birth asphyxia are known to be associated with this condition. Maternal factors also predispose to this condition. Early detection and appropriate management is of utmost importance to prevent complications. The aim of the study is to evaluate the predisposing factors for neonatal thrombocytopenia in a teaching hospital. METHODS This was a cross sectional observational study done in the Department of Peadiatrics, MediCiti Institute of Medical Sciences, Medchal, Telangana, for a duration of one year i.e., from January 2019 to December 2019. A total of 60 neonates with thrombocytopenia were studied for onset of thrombocytopenia, severity based on platelet counts, aetiology and for contributing maternal factors. RESULTS Early onset thrombocytopenia (&lt; 3 days of age) was seen in 46.6 % (28 / 60) and late onset thrombocytopenia (3 - 28 days) in 53.3 % (32 / 60). The most common cause for neonatal thrombocytopenia was neonatal sepsis 30 % (10 / 60), followed by birth asphyxia. Common maternal predisposing factors were pregnancyinduced hypertension and pregnancy-induced diabetes mellitus. CONCLUSIONS Neonatal thrombocytopenia is one of the most common clinical problems in neonates. It can be of early or late onset type and has fetal and maternal predisposing factors. Neonatal sepsis is one of the most common cause for neonatal thrombocytopenia followed by birth asphyxia which is a preventable cause. Early diagnosis and thorough evaluation are needed to prevent complications. KEYWORDS Neonatal Thrombocytopenia, Neonatal Sepsis

Incidence and Risk Factors of Thrombocytopenia in Neonates Admitted With Surgical Disorders to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital; A One-Year Observational Prospective Cohort Study From a Low-Income Country

Background: Thrombocytopenia is one of the most common hematologic disorders affecting neonates who are admitted to the neonatal intensive care unit with a reported incidence of 18-35%. Several maternal, neonatal and perinatal factors contribute to the development of thrombocytopenia. This study is aimed to determine the incidence and associated risk factors of neonatal thrombocytopenia. Methods: An observational prospective cohort study was conducted and all neonates admitted to the neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders in the study period were included. Data was collected using a checklist and analysed by SPSS version 23. Chi square test and independent sample T- test were used to asses the association among different variables. Findings: A total of 210 neonates were included in the study out of which 56.2% were males. The incidence of thrombocytopenia in the study period was 55.8%. Among neonates with thrombocytopenia, 90.9% had a late onset thrombocytopenia and half of them were in the severe range (<50,000/µl). The presence of sepsis(P=0.000) and atresia (P=0.000) were found to be significantly associated with the development of thrombocytopenia. The mean non feeding hours were found to be significantly longer for patients with thrombocytopenia (t (199), 5.81, P= 0.000). Interpretation: The incidence of thrombocytopenia in neonates admitted with surgical disorders was high in our institution. Preventive methods towards neonatal sepsis including antenatal and postnatal measures should be given due emphasis. Initiation of oral feedings in neonates as early as feasible is recommended. Funding Statement: Addis Ababa University has granted the fund for this study. Declaration of Interests: None. Ethics Approval Statement: Written informed consent was taken from parents of enrolled neonates and each neonate’s clinical data was kept in confidential manner using a coding system. Ethical clearance for this study was obtained from ethical board of the medical college.

Neonatal Thrombocytopenia: Its associated risk factors and outcome in NICU in a tertiary hospital in Nepal

ABSTRACTBackground: Thrombocytopenia is a frequently encountered hematological abnormality in Neonatal Intensive Care Unit (NICU). There are various maternal and neonatal risk factors associated and the incidence varies greatly depending upon the population studies. This study was performed on neonates admitted in Bharatpur Hospital NICU.Materials &amp; Methods: In this retrospective study, 412 neonates who were admitted in NICU from November 2016 to October 2017 were included in the study. Frequency of thrombocytopenia was determined along with associated maternal and neonatal risk factors. Maternal risk factors like Pregnancy induced hypertension (PIH), Diabetes, Eclampsia, drug use and neonatal risk factors like sepsis, asphyxia, intrauterine growth retardation (IUGR), prematurity were analyzed. Requirement of platelet transfusion and the outcome were also evaluated. Results: Of the 412 neonates included, 74 had thrombocytopenia which comprised approximately 18% neonates admitted in NICU. Early onset thrombocytopenia occurring within 72 hrs comprised 91.8% while late onset thrombocytopenia occurring after 72 hrs comprised 8.2% of total thrombocytopenia. 58.1% (43) were mild , 29.7% (22) moderate and 12.2% (9) severe thrombocytopenia. The major neonatal risk factors were sepsis, asphyxia, IUGR and prematurity while gestational diabetes and PIH were maternal risk factors contributing to neonatal thrombocytopenia. Only 4.05% received platelet transfusion. 77.03% of the neonates recovered and were discharged while 12.16% neonates were referred to other centres and 5.40% neonates died.Conclusion: Neonatal thrombocytopenia accounted for 18% of neonates which were admitted in the NICU. Significant neonatal risk factors were asphyxia and sepsis and maternal risk factors were PIH and diabetes. Majority did not require platelet transfusion and outcome was also good.

Generalized erythroderma in a neonate: Rare presentation of nosocomial candidemia with Candida tropicalis

Candida species are currently one of the most common causes of nosocomial infection in neonatal intensive care units with Candida tropicalis emerging as a frequent offending agent. Colonization precedes systemic invasive fungal infections in neonates. It generally manifests with lethargy, increased apneic episodes, feeding intolerance, late-onset thrombocytopenia, hypoglycemia, unexplained hyperglycemia, poor perfusion, and need for increased ventilator requirement. We report a 10-day-old neonate, with late-onset sepsis by C. tropicalis, presenting as generalized erythroderma. We present this case to highlight that nosocomial candidemia with C. tropicalis can present as generalized erythroderma in neonates. Maintaining adequate oral or parenteral fluidintake with monitoring of serum electrolytes is mandatory.

Study of risk factors of neonatal thrombocytopenia

Background: Neonatal thrombocytopenia (platelet count &lt; 1.5 lac/µl) is the commonest haematological abnormality encountered in neonatal intensive care unit (NICU). Thrombocytopenia if not detected can result in devastating complications. Determining the risk factors of thrombocytopenia enables us to prevent the inevitable and irreversible complications. The present study highlights the pattern, severity and risk factors of neonatal thrombocytopenia in our hospital.Methods: Prospective observational study was conducted on 200 neonates with thrombocytopenia admitted in NICU of our hospital. Maternal and neonatal risk factors were recorded. Neonates were grouped based on the severity of thrombocytopenia. The risk factors were compared with severity of thrombocytopenia.Results: 200 neonates with thrombocytopenia were divided into three groups based on severity of thrombocytopenia. 81% of babies had moderate to severe thrombocytopenia. The most common maternal predisposing factors were pregnancy induced hypertension (PIH), premature rupture of membranes (PROM) and anemia.62.5% babies were low birth weight babies and they had severe thrombocytopenia. 56% babies had late onset neonatal thrombocytopenia and 44% had early onset thrombocytopenia. The most common neonatal risk factors were sepsis in 48.5% babies and birth asphyxia in 20% babies.Conclusions: The severity of neonatal thrombocytopenia in our NICU was moderate to severe type. PIH, PROM and anemia were the commonest maternal risk factors. Preterm and low birth weight babies had severe thrombocytopenia. Sepsis and birth asphyxia were the commonest neonatal risk factors. Birth asphyxia was associated with early onset neonatal thrombocytopenia and sepsis was associated with late onset thrombocytopenia. Severe thrombocytopenia can be used as a prognostic indicator in sick neonates.

Neonatal Platelet Transfusions and Future Areas of Research.

Thrombocytopenia affects approximately one fourth of neonates admitted to neonatal intensive care units, and prophylactic platelet transfusions are commonly administered to reduce bleeding risk. However, there are few evidence-based guidelines to inform clinicians' decision-making process. Developmental differences in hemostasis and differences in underlying disease processes make it difficult to apply platelet transfusion practices from other patient populations to neonates. Thrombocytopenia is a risk factor for common preterm complications such as intraventricular hemorrhage; however, a causal link has not been established, and platelet transfusions have not been shown to reduce risk of developing intraventricular hemorrhage. Platelet count frequently drives the decision of whether to transfuse platelets, although there is little evidence to demonstrate what a safe platelet nadir is in preterm neonates. Current clinical assays of platelet function often require large sample volumes and are not valid in the setting of thrombocytopenia; however, evaluation of platelet function and/or global hemostasis may aid in the identification of neonates who are at the highest risk of bleeding. Although platelets' primary role is in establishing hemostasis, platelets also carry pro- and antiangiogenic factors in their granules. Aberrant angiogenesis underpins common complications of prematurity including intraventricular hemorrhage and retinopathy of prematurity. In addition, platelets play an important role in host immune defenses. Infectious and inflammatory conditions such as sepsis and necrotizing enterocolitis are commonly associated with late-onset thrombocytopenia in neonates. Severity of thrombocytopenia is correlated with mortality risk. The nature of this association is unclear, but preclinical data suggest that thrombocytopenia contributes to mortality rather than simply being a proxy for disease severity. Neonates are a distinct patient population in whom thrombocytopenia is common. Their unique physiology and associated complications make the risks and benefits of platelet transfusions difficult to understand. The goal of this review was to highlight research areas that need to be addressed to better understand the risks and benefits of platelet transfusions in neonates. Specifically, it will be important to identify neonates at risk of bleeding who would benefit from a platelet transfusion and to determine whether platelet transfusions either abrogate or exacerbate common neonatal complications such as sepsis, chronic lung disease, necrotizing enterocolitis, and retinopathy of prematurity.

Study of thrombocytopenia in neonatal intensive care unit

Background and Objectives: Neonatal thrombocytopenia (platelet count less than 150×109/L) is one of the commonest hematological abnormality encountered in neonatal intensive care unit (NICU). Though thrombocytopenia is so prevalent it is often overlooked assuming that it will resolve spontaneously. However, if it is not detected and managed properly can result in devastating complications. The present study highlights the pattern, prevalence, severity and possible causes of neonatal thrombocytopenia encountered in our hospital. Method: A prospective observational study was conducted on sick neonates admitted to NICU with different clinical problems and were evaluated for pattern and severity of thrombocytopenia as per the blood samples analysed. Results: Out of 155 consecutive neonates admitted to NICU, 99 developed thrombocytopenia with a high prevalence of 63.8%. 43.4% had early onset and 56.5% had late onset thrombocytopenia. The most common cause of neonatal thrombocytopenia was prematurity (38.3%) followed by neonatal sepsis (22.2%). Mild and moderate thrombocytopenia was found in 17.1% of the neonates each, while severe was more common accounting for 65.6% of cases. Conclusion: Neonatal thrombocytopenia is common in NICU and it could be used as a prognostic marker for multiple diseases. As its clinical course and outcome depend on etiology, an appropriate diagnostic workup is essential for early diagnosis and better management. Key words: Neonate, thrombocytopenia, neonatal intensive care unit, pattern of thrombocytopenia

The transfusion‐related acute lung injury controversy: lessons from heparin‐induced thrombocytopenia

The transfusion‐related acute lung injury controversy: lessons from heparin‐induced thrombocytopenia

Evaluation and management of thrombocytopenic neonates in the intensive care unit

Thrombocytopenia is a very frequent problem among sick neonates, affecting up to 35% of all infants admitted to the neonatal intensive care unit (NICU), and serves as an important indicator of multiple clinical conditions. The cause of the thrombocytopenia is unclear in up to 60% of affected neonates. A clinical classification of thrombocytopenia is based on the time of presentation, early (≤72 hours of life) vs. late (>72 hours of life). Early thrombocytopenia is commonly associated with feto-maternal conditions, is most commonly caused by disorders associated with placental insufficiency, and is generally mild to moderate and resolves spontaneously within 7-10 days without any intervention. In contrast, neonates who develop late-onset thrombocytopenia frequently have bacterial sepsis or necrotizing enterocolitis. It is often severe (platelets <50,000/μL), prolonged and frequently requires multiple platelet transfusions. Platelet transfusions represent the only specific therapy currently available for most thrombocytopenic neonates, even though much evidence suggests that platelet transfusions are not benign. Many of the prophylactic platelet transfusions currently given to NICU patients are unnecessary, convey no benefits, and carry known and unknown risks. For this reason, pharmacological alternatives have been investigated as potential therapies for thrombocytopenia, but they still have limited use treating the common varieties of neonatal thrombocytopenia.

How I manage neonatal thrombocytopenia

Although neonatal thrombocytopenia (platelet count < 150×10(9) /l) is a common finding in hospital practice, a careful clinical history and examination of the blood film is often sufficient to establish the diagnosis and guide management without the need for further investigations. In preterm neonates, early-onset thrombocytopenia (<72h) is usually secondary to antenatal causes, has a characteristic pattern and resolves without complications or the need for treatment. By contrast, late-onset thrombocytopenia in preterm neonates (>72h) is nearly always due to post-natally acquired bacterial infection and/or necrotizing enterocolitis, which rapidly leads to severe thrombocytopenia (platelet count<50×10(9) /l). Thrombocytopenia is much less common in term neonates and the most important cause is neonatal alloimmune thrombocytopenia (NAIT), which confers a high risk of perinatal intracranial haemorrhage and long-term neurological disability. Prompt diagnosis and transfusion of human platelet antigen-compatible platelets is key to the successful management of NAIT. Recent studies suggest that more than half of neonates with severe thrombocytopenia receive platelet transfusion(s) based on consensus national or local guidelines despite little evidence of benefit. The most pressing problem in management of neonatal thrombocytopenia is identification of safe, effective platelet transfusion therapy and controlled trials are urgently needed.

Prognostic significance of delayed thrombocytopenia after allogeneic stem cell transplant

Previous studies showed that late-onset thrombocytopenia is a strong negative prognostic indicator of survival in allogeneic hematopoietic stem cell transplant (SCT) recipients and, in particular, in those cases where thrombocytopenia is related to chronic graft versus host disease (cGVHD) [1–12]. To investigate this issue, 71 adult patients who survived for 3 months with median follow-up time of 21 months (range, 3–44 months) after SCT were evaluated. Twenty-seven patients (38%) developed thrombocytopenia with a median platelet count of 29 3 10/L. Patients with and without thrombocytopenia had similar baseline clinical characteristics, transplant type, and status at transplant. The incidence of mortality was significantly higher in patients with post-SCT thrombocytopenia (70% vs. 14%; P 50 < 100 3 10/L in eight patients and 50 3 10/L in 19 among whom 9 had 20 3 10/L. Thrombocytopenia was transient in 5 and persistent in 22 patients; in this last group the median duration of thrombocytopenia was three months. Patients with and without thrombocytopenia were similar in baseline clinical characteristics, type of transplant, and status at transplant (Table II). Thrombocytopenia was associated with cGVHD in 10 out of 24 patients (42%) (three patients with thrombocytopenia were not evaluable for cGVHD), disease relapse in seven patients (26%; five acute leukemia and two lymphomas), CMV infection in four patients (15%), graft failure in two patients, and microangiopathy in one patient; three patients had idiopathic thrombocytopenia. Thrombocytopenia was complicated with major intestinal bleeding and cerebral bleeding in four and two patients, respectively. The incidence of mortality was significantly higher in patients with postSCT thrombocytopenia compared with patients without thrombocytopenia (19 out of 27 [70%] vs. 6 out of 44 [14%] patients; P < 0.0001) (Fig. 1). The cause of mortality in patients with thrombocytopenia included: primary disease in 11 patients (58%; acute leukemia in five patients, lymphoma in three patients, one patient each myelodysplasia, chronic myeloid leukemia, and multiple myeloma), cGVHD in three patients (16%), infections in two patients (10.5%), one patient each with cerebral bleeding, cardiac stroke and multiorgan failure. Patient survival after 12, 24, and 33 months was 93%, 87%, and 87% in patients without thrombocytopenia vs. 41%, 41%, and 7% in patients with thrombocytopenia, respectively (P < 0.0001) (Fig. 1). In univariate analysis using Cox proportional hazard model, overall survival (OS) showed a significant association with status at transplant (no response/progression vs. complete remission Hazard Ratio [HR] 2.74; 95% confidence interval [CI], 1.11–6.79; P 5 0.03) and thrombocytopenia (HR 9.77; 95% CI, 3.63–26.33; P < 0.0001). In multivariate analysis only thrombocytopenia was significantly associated with OS (HR 9.77; 95% CI, 3.63–26.33; P < 0.0001). In order to eliminate possible bias related to disease-related mortality we repeated the analysis excluding 15 patients who died because of primary diseases and not for SCT related mortality. Fifteen out of the remaining 56 patients developed post SCT thrombocytopenia and again, the incidence of mortality was significantly higher in patients with thrombocytopenia, i.e. 8 out of 15 (53%) vs. 4 out of 41 (10%) (P 5 0.001). In univariate analysis using Cox proportional hazard model, thrombocytopenia resulted the only variable significantly associated with OS (HR 7.83; 95% CI, 2.34–26.00; P 5 0.001). TABLE I. Summary of Patients’ Clinical and Transplant Baseline Characteristics

Nosocomial sepsis-induced late onset thrombocytopenia in a neonatal tertiary care unit: A prospective study

Late onset sepsis (LOS)( onset of sepsis >72 hours of age or nosocomial sepsis) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). Thrombocytopenia is an important complication of sepsis. We investigated the incidence of thrombocytopenia in LOS patients and studied the influence of various parameters on platelet response. Infants born in the level 3 neonatal intensive care unit between January 2002 and December 2006 with documented LOS were included in this prospective study. Multiple hemograms with platelet counts, bacterial blood culture and fungal blood culture were obtained in all patients. Demographic and clinical data were compared between patients without thrombocytopenia and with mild, moderate and severe thrombocytopenia. Duration of thrombocytopenia in relation to type of organism and mortality with respect to degree of thrombocytopenia were also studied. Of 200 patients with culture-proven nosocomial sepsis, 119 (59.5%) patients developed thrombocytopenia (platelet count <150 X 109/L). In our series Klebsiella pneumoniae was the most frequently isolated organism (125/200, 62.5%) and the incidence of thrombocytopenia was 60.0% (75/125). However, the incidence of thrombo- cytopenia was highest among patients who had concurrent bacterial and fungal sepsis (28/31, 90.3%). Coagulase- negative staphylococcal (CoNS) sepsis was present in 21 (10.5%) patients and the incidence of thrombocytopenia was 33.3%. Isolated fungal sepsis was present only in 6 (3%) patients and the incidence of thrombocytopenia was 66.0%. The incidence of thrombocytopenia was highest among preterm babies and low-birth weight (LBW) babies. Twenty-seven percent (54/200) of babies presented with mild thrombocytopenia, 20% (40/200) presented with moderate thrombocytopenia, and 12.5%(25/200) developed severe thrombocytopenia. Severity of thrombocytopenia was also directly related to the presence of necrotizing enterocolitis (NEC) and disseminated intravascular coagulation (DIC). The mortality rate was significantly associated with the degree of thrombocytopenia. LOS sepsis is an important risk factor for thrombocytopenia in the NICU. Fungal and gram- negative sepsis are frequently associated with a decreased platelet count. Sepsis-induced thrombocytopenia is more common among LBW babies and preterm babies. The mortality rate is significantly related to degree of thrombocytopenia.

Petechial Rash in Neonates: Management Algorithm

Petechial rash in neonatal period commonly results from thrombocytopenia. Disorders of coagulation and those affecting vascular integrity may cause purpuric rash. Common causes of neonatal thrombocytopenia include early onset thrombocytopenia (onset &lt; 72 hours) due to placental insufficiency, perinatal asphyxia, perinatal infections and DIC. Atloimmune thrombocytopenia is rare but potentially serious disorder. Late onset thrombocytopenia (onset &gt; 72 hours) almost always results from sepsis and NEC. Intrauterine infections and perinatally acquired dengue and chikungunaya infections also need to be considered in appropriate clinical settings. Infantile acute hemorrhagic edema, meningococcal rash and blue berry muffin baby are causes of purpuric rash without thrombocytopenia and may require exclusion. In addition to these, this review also includes uncommon causes of petechial/ purpuric rash in neonatal period. Clinical approach to diagnosis and management are discussed.