Neonatal Platelet Count Research Articles

Is it possible to predict morbidities in neonates born to mothers with immune thrombocytopenic purpura?: A retrospective cross-sectional study.

Immune thrombocytopenic purpura (ITP) comprises ~1% to 4% of thrombocytopenia cases during pregnancy. Factors predicting neonatal thrombocytopenia and associated morbidities due to maternal ITP are unclear. The present study aimed to assess the neonatal outcomes of pregnant women with ITP. Fifty-five pregnant women with ITP and their babies, born between January/2013 and April/2021, were retrospectively reviewed. Maternal and neonatal thrombocytopenia cases other than ITP were excluded from the study. Physical examination, blood count, and cranial/abdominal ultrasonography findings of the newborns were recorded. Neonatal thrombocytopenia was defined as a platelet count < 150 × 109/L. Relationship between neonatal thrombocytopenia and maternal factors was investigated. Thrombocytopenia was detected in 17/55 babies (30.9%), and 8/17 (47.1%) had symptoms of bleeding, all but one being mild bleeding. There was a significant correlation between neonatal platelet counts of < 100 × 109/L and maternal splenectomy history. Incidence of moderate and severe thrombocytopenia was higher (statistically insignificant) in neonates of mothers with ITP. No significant correlation was determined between maternal and neonatal platelet counts. There was a weak insignificant correlation between platelet counts of neonates of mothers with or without thrombocytopenia. A significant correlation was found between the presence of splenectomy before delivery in the mother and a platelet count of < 100 × 109/L in the neonate. Moderate and severe thrombocytopenia was higher in neonates of mothers diagnosed with ITP before pregnancy and needed treatment during pregnancy and/or delivery, but the difference was insignificant. Close follow-up of babies born to mothers with ITP after birth is crucial since there is no significant prediction criterion for developing neonatal thrombocytopenia and associated morbidities.

Neonatal Extracorporeal Membrane Oxygenation: Associations between Continuous Renal Replacement Therapy, Thrombocytopenia, and Outcomes

Plain Language SummaryHeart and lung life support, or extracorporeal membrane oxygenation (ECMO), is a form of life support that can be utilized in critically ill neonates. Continuous dialysis, or continuous renal replacement therapy (CRRT), can be used in conjunction with ECMO to help support and supplement kidney function. The frequency of low platelet counts in neonates receiving ECMO with and without concurrent CRRT and associated outcomes have not been well described in the literature. The primary aims of the current study were to (1) characterize low platelet counts in neonates receiving ECMO (including those treated concurrently with CRRT) and (2) evaluate risk factors (including CRRT utilization) associated with low platelets. In our study, CRRT use during ECMO was associated with severely low platelet counts. Exploratory analysis suggests CRRT use, birthweight, and intensive care unit location are all predictors of interest for low platelet counts and worthy of further investigations in larger studies.

Neonatal Outcomes in Pregnant Women Complicated with Immune Thrombocytopenic Purpura

Background: Maternal antibodies that interact with both maternal and fetal platelets cause autoimmune thrombocytopenia. This happens in autoimmune diseases of the mother, such as immune thrombocytopenia purpura (ITP). Objective: The aim of the study was to evaluate the treatment and prognosis of newborns whose mothers had ITP. Methods: A multi center prospective study was carried out at the Duhok Obstetrics and Gynaecology Teaching Hospital and Kurdistan Private Hospital in Iraqi Kurdistan between November 2016 and November 2022. The requirements for inclusion were all expectant mothers with verified ITP diagnoses. Every newborn was monitored in the neonatal intensive care unit and had their thrombocytopenia assessed on their first day of life. Maternal age, parity, diagnosis time, history of previous splenectomy, platelet count at delivery and in the early stages of pregnancy, propensity for bleeding throughout pregnancy, treatment for ITP, and method of delivery based on obstetric circumstances were all noted. the baby's gender, gestational age at delivery, the neonatal platelet count at birth, haemorrhage, and thrombocytopenia therapy. Nominal variable statistics were expressed. Results: 25 neonates delivered by pregnant mothers with ITP during the trial period were all included in the analysis. The ITP patients' mothers were between 23 and 33 years old. There were 14 (56%) multigravida cases and 11 (44%) primigravida cases. Prior to three years of pregnancy, just one (4%) instance had a history of splenectomy. The mother's platelet count at delivery was less than 50 × 109/L in 7 (28%) cases. Thirteen (52%), utilised corticosteroids. Ten (40%) of the deliveries were caesarean sections. Two (8%) cases had gestational ages between 33 and 36.6 weeks, whereas 23 (92% of cases) had gestational ages between 37 and 38 weeks. In 12 (48%) cases, the birth weight ranged from 1200 to 2500 kg, whereas in the other cases, it was between 250 and 3300) kg in 13(52%) cases the new-born baby's gender was male. Twelve (48%) of the newborns had thrombocytopenia. Just three cases (about 25%) needed medical attention. Conclusion: Pregnancy counselling is necessary for a woman with a history of ITP in order to maximise her platelet count. While serious bleeding is uncommon in neonates with maternal ITP. Corticosteroids are an effective therapeutic option for both the mother and the new-born

Prednisone Plus Ivig Compared with Prednisone for Immune Thrombocytopenia during Pregnancy

Introduction Immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by an isolated low platelet count and is the most common cause of thrombocytopenia during pregnancy, accounting for 1%-4% of thrombocytopenia in pregnant women. Women with ITP who have severe thrombocytopenia are at an increased risk for life-threatening obstetric complications. However, management of ITP during pregnancy can be challenging because treatment choices are limited. Corticosteroids or intravenous immunoglobulin (IVIg) are recommended as first-line treatments for pregnant women with ITP, but the response to initial treatment is approximately 39% and 38%, respectively, lower than that in nonpregnant patients with ITP. Therefore, in-depth studies investigating new solutions for the first-line treatment of ITP during pregnancy are urgently needed. Our previous retrospective study revealed an advantage of prednisone combined with IVIg compared to prednisone monotherapy for pregnant patients with ITP. Therefore, the aim of this prospective, randomized, open-label study was to further assess the efficacy and safety of prednisone plus IVIg compared to prednisone monotherapy in pregnant women with ITP. The study has been registered at clinicaltrials.gov. NCT05333744 Methods Eligible treatment-naive ITP patients during pregnancy with a platelet count &amp;lt; 30 × 10^9/L, accompanied by or without bleeding symptoms, were randomly assigned 1:1 to receive prednisone 20 mg per day for 4 weeks plus IVIg 400 mg/kg (total dose ≤20 g per day) for 5 days or prednisone 20 mg monotherapy per day for 4 weeks. Prednisone was gradually tapered to the maintenance dose of 5-10 mg per day until 6 weeks after delivery if there was a response to treatment; otherwise, prednisone was gradually tapered to withdrawal. The primary outcome was overall response (OR), defined as a platelet count ≥ 30 × 10^9/L, a doubling of the baseline platelet count and the absence of bleeding. Secondary endpoints included complete response (CR), time to response, platelet counts at delivery, platelet counts of newborns, and adverse events in parturients. CR was defined as platelet count ≥100×10^9/L measured on 2 occasions at least 7 days apart and the absence of bleeding. Results A total of 100 treatment-naive ITP patients during pregnancy were randomly assigned to either the prednisone plus IVIg (n=50) or prednisone monotherapy (n=50) groups. All the baseline characteristics were comparable between the two groups. The median ages of patients in the prednisone plus IVIg group and prednisone monotherapy group were 30.32 years (range, 22-43) and 30 years (range, 28-46), respectively. For patients in the combination and monotherapy groups, the mean estational ages at intervention start were 28.3 weeks and 30.9 weeks, respectively. All patients were followed up for more than 2 months. OR was observed in 23 (46.0%) patients in the combination group and 22 (44%) in the monotherapy group, and no significant difference was observed between the two groups (p=0.91). A significant difference was observed in the time to response between the prednisone plus IVIg group and prednisone monotherapy group (6.14 days vs. 9.84 days, p=0.001). However, the predelivery platelet transfusion of the prednisone plus IVIg group was greater than that of the prednisone monotherapy group. There were no significant differences in the delivery mode between the combined group and monotherapy group. No significant differences were found between the two groups in neonatal outcomes, particularly concerning the neonatal platelet counts. Conclusion Prednisone plus IVIg was an effective and safe treatment for ITP in pregnancy, and this therapy may be a new first-line treatment option for pregnant patients with ITP.

Risk of thrombocytopenia in neonates of thrombocytopenic mothers.

Maternal thrombocytopenia during pregnancy may occur due to several possible etiologies, with potential neonatal impact. The aim of the present study was to investigate whether there is a correlation between maternal and neonatal platelet count among women with thrombocytopenia during pregnancy. A cross-sectional retrospective study (2012-2019) was conducted at a tertiary medical center. Complete blood count was routinely measured in all patients on admission to the delivery ward. Thrombocytopenia was defined as a platelet count below 150 K/μL. Clinical and outcome parameters of thrombocytopenic mothers and their newborns were collected from the electronic files and analyzed by severity of maternal thrombocytopenia. Of 45 385 women with a documented platelet count at admission, 2841 (6.24%) had thrombocytopenia: 2623 (5.7%) mild (100-149 K/μL), 207 (0.45%) moderate (50-99 K/μL), and 11 (0.02%) severe (<50 K/μL). Eight newborns had thrombocytopenia; corresponding rates by severity of maternal thrombocytopenia were 0.11%, 1.43%, and 18.18% (P = 0.04). None of the thrombocytopenic neonates had an intraventricular hemorrhage or other bleeding complications. The correlation between maternal and neonatal platelet counts was weak (Pearson r = 0.038; P = 0.046). We suggest that although the chances of neonatal thrombocytopenia are higher with worsening maternal thrombocytopenia, actual occurrence is rare, and the correlation is poor. Therefore, maternal thrombocytopenia cannot be regarded as a significant risk factor for neonatal thrombocytopenia. Neonatal platelet count should be obtained when maternal thrombocytopenia is autoimmune or less than 100 K/μL.

Predictive effects of platelet-to-lymphocyte ratio on neonatal thrombocytopenia in primary immune thrombocytopenic mothers: a retrospective cohort study

BackgroundPrimary immune thrombocytopenia (ITP) can increase the risk of neonatal thrombocytopenia (NT). This study aimed to investigate the key factors for predicting the risk of NT.MethodsData were retrospectively collected from all pregnant women with ITP from 2015 to 2021. Newborns were divided into two groups according to the presence or absence of NT. The parameters between the two groups were then compared. Next, the correlation between maternal platelet-to-lymphocyte ratio (PLR) and neonatal platelet count was analyzed by logistic regression and generalized additive model. Additionally, the relationships among the platelet counts of siblings were also determined.ResultsA total of 147 maternal cases were included. NT was observed in 46 (31.72%) neonates. A history of previous children with NT appeared to have predictive value for NT (OR 16.484, 95% CI 2.212–122.858, P < 0.001), as the nadir gestational platelet (OR 0.958, 95% CI 0.93–0.988, P < 0.001). Correlation analysis of platelet count on postnatal day 1 and the nadir platelet count in 36 sibling neonates showed a positive correlation (r=0.684, P<0.001; r=0.900, P<0.05). PLR was divided into 3 groups via tertiles, and the incidence of NT was dramatically higher in the group with lower PLR during the second and third trimesters than in the other two groups (48.5% vs 33.3% vs 22%, P<0.05; 50% vs 21.3% vs 26.7%, P<0.001). Moreover, the risk of NT was markedly higher in the first trimester (PLR < 78.51; OR 0.975, 95% CI 0.951–0.999, P<0.05) and the second trimester (PLR < 20.41; OR, 0.899, 95% CI 0.820–0.985, P<0.05) compared to the third trimester.ConclusionOur findings suggest that a history of previous children with NT is a significant factor for predicting NT in subsequent pregnancies. PLR in the first, second and third trimesters can also be used as a reference to predict NT risk.

Fetal and neonatal alloimmune thrombocytopenia: No evidence of systemic inflammation as a modulator of disease severity. Couldplacental inflammation be key?

In fetal/neonatal alloimmune thrombocytopenia (FNAIT), maternal alloantibodies against paternal human platelet antigens (HPA) cross the placenta and lead to platelet destruction. The extent of thrombocytopenia varies among neonates, and inflammation may constitute an important trigger. A set of stable inflammatory markers was measured in serum samples from neonates with low platelet counts, of which n = 50 were diagnosed with FNAIT due to anti-HPA-1a antibodies and n = 50 were thrombocytopenic without detectable maternal HPA antibodies. Concentrations of C-reactive protein, soluble CD14, procalcitonin, and sFlt-1 did not differ between the two cohorts. There was no correlation between C-reactive protein or soluble CD14 and the platelet count, but a negative correlation between procalcitonin concentrations and the neonatal platelet count in both cohorts. sFlt-1 concentration and the platelet count were correlated in FNAIT cases exclusively. None of the inflammatory markers was statistically different between cases with and without intracranial haemorrhage. We were unable to identify systemic inflammation as a relevant factor for thrombocytopenia in FNAIT. The antiangiogenic enzyme sFlt-1, released by the placenta, did correlate with the platelet count in FNAIT cases. Our findings may give rise to the hypothesis that placental inflammation rather than systemic inflammation modulates disease severity in FNAIT.

Effect of phototherapy on platelet count in neonates with unconjugated hyperbilirubinemia

Background: Hyperbilirubinemia in newborn is quite common. Phototherapy (PT) is one of the most common noninvasive methods for the treatment of this hyperbilirubinemia. There are limited studies available on effect of PT on platelet count with contrasting results. So, this study was conducted to determine the effect of phototherapy on platelet counts of hyperbilirubinemic neonates in tertiary care hospital. Methods: This was a hospital based prospective study on 60 eligible neonates admitted in neonatal intensive care unit (NICU) for neonatal hyperbilirubinemia and phototherapy during January 2021 to June 2022. Platelet count was done before starting phototherapy, 24 hours after phototherapy and before discontinuing phototherapy. The results were analyzed statistically using Chi square test and t-test. P value &lt;0.05 was considered as statistically significant. Results: In this study, total of 60 neonates were included of which 33 were males and 27 were females. The mean (±SD) platelet counts were 201764.92±18 before phototherapy and 156578.33±38 after phototherapy. There was a significant decline in the mean platelet count 24 hours after phototherapy and before stopping phototherapy. (p&lt;0.05). Conclusions: In our study, the mean platelet count was decreased significantly after phototherapy. Hence, unnecessary use and prolongation of phototherapy should be avoided.

Diagnostic Ideas and Management Strategies for Thrombocytopenia of Unknown Causes in Pregnancy.

ObjectiveTo summarize the clinical characteristics and treatment options together with the maternal and neonatal prognoses in women with different degrees of thrombocytopenia of unknown causes during pregnancy.Materials and MethodsOne hundred twenty-nine cases meeting the inclusion and exclusion criteria were retrospectively analyzed. Patients were divided into group A (50*109/L) and group B (50*109/L to 100*109/L) according to the lowest level of platelet count during pregnancy. Patients were divided into those found to have thrombocytopenia in the relatively early, middle, and late stages according to the detection period of maternal thrombocytopenia during pregnancy.ResultsThere were 72 cases in group A, and 57 cases in group B. There existed statistically significant differences in terms of the proportion of primipara, the proportion with a history of thrombocytopenia, and the median length of pregnancy between the two groups (p < 0.05). The proportion of patients with severe thrombocytopenia as an indication for cesarean delivery was higher in group A than in group B (p < 0.05). More cases were detected at the relatively early stages of pregnancy in group A than in group B (p < 0.05). There was no difference in neonatal hemorrhage and events of thrombocytopenia between the two groups.ConclusionPatients with platelet counts below 50*109/L were mostly primipara with a history of thrombocytopenia, most often detected at a relatively early stage of pregnancy, and continued pregnancy might lead to aggravation of the disease. Combination therapy was required for patients with platelet counts below 30*109/L to maintain the platelet counts within a safe range. Cesarean delivery was selected to terminate the pregnancies, and platelet counts should be raised above 50*109/L before surgery. Close monitoring was required for those with platelet counts above 30*109/L. There was no direct correlation between the maternal and neonatal platelet counts.

Anti-human platelet antigen-5b antibodies and fetal and neonatal alloimmune thrombocytopenia; incidental association or cause and effect?

Most cases of fetal and neonatal thrombocytopenia (FNAIT) are caused by maternal anti-human platelet antigen-1a antibodies (anti-HPA-1a). Anti-HPA-5b antibodies are the second most common antibodies in suspected FNAIT cases. Given the high prevalence of anti-HPA-5b antibodies in pregnant women delivering healthy newborns, the association with FNAIT may be coincidental. This review of the literature related to FNAIT using the MEDLINE database was conducted according to PRISMA guidelines. A retrospective analysis of a single-centre cohort of 817 suspected FNAIT cases was conducted. The pooled prevalence of anti-HPA-5b antibodies in unselected pregnant women of European descent was 1.96% (n=3113), compared with 3.4% (n=5003) in women with suspected FNAIT. We found weak evidence that a small proportion of pregnant women presenting with anti-HPA-5b antibodies will give birth to a newborn with mild thrombocytopenia. The neonatal platelet counts were not different between suspected FNAIT cases (n=817) with and without maternal anti-HPA-5b antibodies. The prevalence of maternal anti-HPA-5b antibodies was not different between neonates with intracranial haemorrhage and healthy controls. The current experimental and epidemiological evidence does not support the hypothesis that anti-HPA-5b antibodies cause severe thrombocytopenia or bleeding complications in the fetus or newborn.

2021 Chinese consensus on the diagnosis and management of primary immune thrombocytopenia in pregnancy.

2021 Chinese consensus on the diagnosis and management of primary immune thrombocytopenia in pregnancy.

Quantitative Analysis of Thrombocytes in Neonates in a Tertiary Care Centre of Southern India- A Retrospective Study

Introduction: Thrombocytopenia is defined as a platelet count of less than 150×109/L, which is also applicable to newborn infants. It may be a result of increased platelet destruction (immune and non immune), decreased platelet production, and a combination of both or unknown. A platelet count of more than 500×109/L is considered thrombocytosis, classified as primary or essential and secondary or reactive. Abnormal platelet count being quite common, is most often neglected and it can lead to devastating complications if untreated. Aim: To study the incidence of abnormal platelet counts and to determine the risk factors associated with abnormal platelet counts in neonates admitted to the Neonatal Intensive Care Unit (NICU). Materials and Methods: A retrospective analysis of platelet count of all neonates admitted to a tertiary NICU of RL Jalappa Hospital, Tamaka, Karnataka, India, between July 2020 and June 2021 was done to determine the incidence and risk factors associated with abnormal platelet count (thrombocytopenia and thrombocytosis). Data of all the neonates were collected retrospectively from July 2021 to August 2021 and analysed. A total of 562 neonates were included in the study. Categorical data was taken and expressed in the form of frequencies and percentages. Data were entered as frequencies using Microsoft excel version 2203 and analysed using Statistical Package for Social Sciences (SPSS) software version 22.0. Chi-square and Fischer’s exact test were used to determining the significance of the data. The p-value &lt;0.05 was considered statistically significant. Results: Out of 629 neonates admitted, 562 neonates were included in the study. Total 209 neonates had thrombocytopenia, with early thrombocytopenia being in 94 (45%) and late being in 115 (55%). Thrombocytosis was seen in only 15 neonates where 7 (46.6%) had early, and 8 (53.3%) had late thrombocytosis. The most common risk factor associated with both cases was sepsis. Placental insufficiency had a statistically significant association with thrombocytopenia (p&lt;0.001**). Term babies had a higher incidence of thrombocytopenia and thrombocytosis, and the association with thrombocytopenia was statistically significant (p=0.043*). Conclusion: Based on the present study, it can be concluded that abnormal platelet count is quite a common finding in sick neonates. Thrombocytopenia is more common than thrombocytosis. The most common risk factor is sepsis, it should not be neglected, and appropriate treatment should be initiated once an abnormal platelet count is detected in neonates.

Platelet transfusion practices in neonatology: A single-center observational study

Aims: Platelet transfusions are common in the neonatal intensive care unit (NICU), yet practices vary substantially. This study aims to determine platelet transfusion incidence, determinants, and justifications in neonatology. Methods: Single-center prospective cohort study, including all patients consecutively admitted to the CHU Sainte-Justine Hospital NICU over a 5-month period in 2013. Data were collected by chart review and transfusion justifications were assessed using a questionnaire. Results: A total of 401 participants were included. Mean birth weight (BW) was 2.34±1.01 kg and gestational age (GA) was 34.4±4.5 weeks. Thirty-seven neonates (9.2%) received at least one platelet transfusion. Platelet-transfused neonates were mostly extremely preterm (40.5%) or term (24.3%). The median pre-platelet transfusion count was 57 × 109/L (9–285 × 109/L). Compared to non-transfused patients, those who received at least one platelet transfusion had a significantly lower BW and GA, higher CRIB-II and SNAPPE-II scores (all p and#60;0.001) and were more frequently admitted for respiratory disease (p and#60;0.001), hypoxic-ischemic encephalopathy (p=0.009), and hemolytic disease of the newborn (p and#60;0.001). Gestational age and#60;28 weeks (pand#60;0.001), mechanical ventilation requirements (p=0.008), and platelet nadir ≤150 × 109/L (pand#60;0.001) upon admission were independently associated with a higher risk of platelet transfusion in this cohort. Most frequent justifications for ordering a first platelet transfusion were low platelet counts (86.5%), underlying disease (78.4%) and illness severity (37.8%). Conclusion: Pre-transfusion platelet counts in neonates varied widely and were higher than the thresholds proposed in the literature. Several factors other than platelet count predicted risk of platelet transfusion in this cohort.

Prevention of Fetal/Neonatal Alloimmune Thrombocytopenia in Mice: Biochemical and Cell Biological Characterization of Isoforms of a Human Monoclonal Antibody.

Maternal alloantibodies toward paternally inherited Ags on fetal platelets can cause thrombocytopenia and bleeding complications in the fetus or neonate, referred to as fetal and neonatal alloimmune thrombocytopenia (FNAIT). This is most commonly caused by Abs against the human platelet Ag (HPA)-1a in Caucasians, and a prophylactic regimen to reduce the risk for alloimmunization to women at risk would be beneficial. We therefore aimed to examine the prophylactic potential of a fully human anti-HPA-1a IgG1 (mAb 26.4) with modified Fc region or altered N-glycan structures. The mAb 26.4 wild-type (WT) variants all showed efficient platelet clearance capacity and ability to mediate phagocytosis independent of their N-glycan structure, compared with an effector silent variant (26.4.AAAG), although the modified N-glycan variants showed differential binding to FcγRs measured in vitro. In an in vivo model, female mice were transfused with platelets from transgenic mice harboring an engineered integrin β3 containing the HPA-1a epitope. When these preimmunized mice were bred with transgenic males, Abs against the introduced epitope induced thrombocytopenia in the offspring, mimicking FNAIT. Prophylactic administration of the mAb 26.4.WT, and to some extent the mAb 26.4.AAAG, prior to platelet transfusion resulted in reduced alloimmunization in challenged mice and normal platelet counts in neonates. The notion that the effector silent variant hampered alloimmunization demonstrates that rapid platelet clearance, as seen with mAb 26.4.WT, is not the sole mechanism in action. Our data thus successfully demonstrate efficient Ab-mediated immunosuppression and prevention of FNAIT by anti-HPA-1a monoclonal variants, providing support for potential use in humans.

Evaluation of Outcome of Pregnancy Complicated with ThrombocytopaeniaA Prospective Observational Study

Introduction: Thrombocytopaenia occurs in 7-12% of pregnancies at the time of delivery. Knowledge, regarding the causes and effects of thrombocytopaenia on mother and newborn, facilitates proper diagnosis and management of thrombocytopaenia in pregnant women for better maternal and foetal outcomes. Aim: To determine the incidence, causes and outcome of pregnancy with Thrombocytopaenia. Materials and Methods: A prospective observational study was conducted among women attending Outpatient Department for an antenatal checkup at NRI Medical College and General Hospital, Chinnakakani, Guntur, Andhra Pradesh, India, from October 2017 to October 2019. A total of 44 antenatal women with platelet count less than 1,50,000/cumm were included in the study. They were followed-up throughout the antenatal period until delivery to record any complications that developed due to low platelet counts in the mother and neonate. A neonatal platelet count was done on day one of life. Data was subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 22.0, all qualitative variables were expressed in terms of proportion. Results: A total of 500 cases were studied of which 50 cases had Thrombocytopaenia with an incidence of 10%. Out of 50 cases, six were lost for follow-up and the remaining 44 cases were included in the study. Out of 44 patients, 52.27% (n=23) had mild thrombocytopaenia, 27.27% (n=12) had moderate and 20.46% (n=9) had severe thrombocytopaenia at the time of diagnosis. Common causes seen were Gestational Thrombocytopaenia (GT) 38.6% (n=17), Preeclampsia (PE) 18.18% (n=8), Gestational hypertension 9.09% (n=4). A total of 11.36% (n=5) required intensive care unit care, 6.81% (n=3) had multiorgan dysfunction syndrome (MODS), 4.54% (n=2) underwent hysterectomy, 4.54% (n=2) had postpartum haemorrhage (PPH), 4.54% (n=2) had secondary suturing done for wound infection, 2.27% (1 patient) underwent laparotomy (for rectus sheath hematoma), and mortality was seen in two cases. A total of 31.8% (14 cases) required blood and blood product transfusions. eight neonates were admitted to the neonatal intensive care unit. There was no case of neonatal thrombocytopaenia. Conclusion: Thrombocytopaenia is a significant problem in pregnancy; hence, the routine antenatal platelet count should be done for a timely diagnosis of thrombocytopenia.

Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study.

Background:The responses of intravenous immunoglobulin (IVIg) or corticosteroids as the initial treatment on pregnancy with ITP were unsatisfactory. This study aimed to assess the safety and effectiveness of prednisone plus IVIg versus prednisone or IVIg in pregnant patients with immune thrombocytopenia (ITP).Methods:Between 1 January 2010 and 31 December 2020, 970 pregnancies diagnosed with ITP at 19 collaborative centers in China were reviewed in this observational study. A total of 513 pregnancies (52.89%) received no intervention. Concerning the remaining pregnancies, 151 (33.04%) pregnancies received an initial treatment of prednisone plus IVIg, 105 (22.98%) pregnancies received IVIg alone, and 172 (37.64%) pregnancies only received prednisone.Results:Regarding the maternal response to the initial treatment, no differences were found among the three treatment groups (41.1% for prednisone plus IVIg, 33.1% for prednisone, and 38.1% for IVIg). However, a significant difference was observed in the time to response between the prednisone plus IVIg group (4.39 ± 2.54 days) and prednisone group (7.29 ± 5.01 days; p < 0.001), and between the IVIg group (6.71 ± 4.85 days) and prednisone group (p < 0.001). The median prednisone duration in the monotherapy group was 27 days (range, 8–195 days), whereas that in the combination group was 14 days (range, 6–85 days). No significant differences were found among these three treatment groups in neonatal outcomes, particularly concerning the neonatal platelet counts. The time to response in the combination treatment group was shorter than prednisone monotherapy. The duration of prednisone application in combination group was shorter than prednisone monotherapy. The combined therapy showed a lower predelivery platelet transfusion rate than IVIg alone.Conclusion:These findings suggest that prednisone plus IVIg may represent a potential combination therapy for pregnant patients with ITP.

The effects of maternal hypertension on the early neonatal platelet count.

To examine the relationship between maternal hypertension and early neonatal platelet counts. This single site retrospective cohort study compared initial platelet counts in the first day of life of infants born to mothers with preeclampsia with severe features (PSF) (n = 224) and infants born to normotensive mothers using multivariable logistic and Quasi-Poisson regressionmodels. There was no statistical difference in initial platelet counts or likelihood of thrombocytopenia (aOR = 1.19, 95% CI 0.68-2.08) between infants born to mothers with PSF and infants born to normotensive mothers after multivariable adjustment. Initial platelet counts and thrombocytopenia risk were unaffected by the presence of maternal end organ dysfunction. Small for gestational age (SGA) status was the most significant risk factor for the development of thrombocytopenia (aOR = 2.24, 95% CI 1.13-4.30). Maternal PSF does not directly affect neonatal initial platelet counts. SGA status confers the greatest risk of early thrombocytopenia.

Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus.

Background: Platelet-rich thrombosis leads to the occlusion of arteries. Whether the association between platelet count and closure of hemodynamically significant patent ductus arteriosus (hsPDA) exists remains inconclusive. Given that neonatal platelet count is significantly affected by infection, this study aims to evaluate the association of platelet parameters before ibuprofen treatment with the closure of hsPDA in very low birth weight (VLBW) infants without concurrent infection.Methods: A retrospective study was conducted at the NICU of Shenzhen Maternity and Child Healthcare Hospital from January 2016 to August 2020. VLBW infants diagnosed with hsPDA, treated with oral ibuprofen and without concurrent infection were included in this study. The platelet parameters were retrieved from the whole-blood test routinely performed within 24 h before starting treatment of oral ibuprofen. A multiple regression model was built to evaluate the association between platelet parameters before ibuprofen treatment and successful closure of hsPDA.Results: A total of 129 premature infants with hsPDA were analyzed in this study. After oral ibuprofen treatment, successful closure of hsPDA was achieved in 70 (54.3%) infants. The gestational age at birth and birth weight in infants with successful or failed closure of hsPDA after ibuprofen treatment were 28.3 vs. 27.6 weeks (p = 0.016) and 1,120 vs. 960 g (p = 0.043), respectively. The rate of mechanical ventilation in infants with successful closure of hsPDA was significantly lower compared to those with failed closure of hsPDA, 31.4 vs. 54.2%, p = 0.014. The platelet count in infants with successful closure of hsPDA after ibuprofen treatment was significantly higher compared to those with failed closure of hsPDA, 212 vs. 183 (in a unit of 109/L), respectively (p = 0.024). Multivariate logistic regression analysis showed that a higher platelet count (≥181 × 109/L) before ibuprofen treatment was independently associated with successful closure of hsPDA [odds ratio 2.556, 95% confidence interval (1.101–5.932), p = 0.029].Conclusion: The findings in this study suggest that a higher platelet count before oral ibuprofen treatment may predict the probability of successful closure of hsPDA in VLBW infants.

Preclinical evaluation of immunotherapeutic regimens for fetal/neonatal alloimmune thrombocytopenia

Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is a life-threatening bleeding disorder caused by maternal antibodies directed against paternally inherited antigens present on the surface of fetal platelets. The human platelet alloantigen HPA-1a (formerly known as the PlA1 alloantigen), is the most frequently implicated HPA for causing FNAIT in Whites. A single Leu33Pro amino acid polymorphism residing within the ∼50-amino-acid plexin-semaphorin-integrin domain near the N-terminus of the integrin β3 subunit (platelet membrane glycoprotein IIIa [GPIIIa]) is responsible for generating the HPA-1a and HPA-1b epitopes in human GPIIIa and serves as the central target for alloantibody-mediated platelet destruction. To simulate the etiology of human FNAIT, wild-type female mice were pre-immunized with platelets derived from transgenic mice engineered to express the human HPA-1a epitope on a murine GPIIIa backbone. These mice developed a strong alloimmune response specific for HPA-1a, and when bred with HPA-1a+ males, gave birth to severely thrombocytopenic pups that exhibited an accompanying bleeding phenotype. Administering either polyclonal intravenous immunoglobulin G or a human monoclonal blocking antibody specific for the HPA-1a epitope into pregnant female mice resulted in significant elevation of the neonatal platelet count, normalized hemostasis, and prevented bleeding. The establishment of an alloantigen-specific murine model that recapitulates many of the clinically important features of FNAIT should pave the way for the preclinical development and testing of novel therapeutic and prophylactic modalities to treat or prevent FNAIT in humans.

Corticosteroids Plus Intravenous Immunoglobulin Compared with Corticosteroids for the Treatment of Immune Thrombocytopenia in Pregnancy: An Observational Multicenter Study in China

Immune thrombocytopenia (ITP) affects 1-10 in 10,000 pregnancies (American College of Obstetricians and Gynecologists, et al. Int J Gynaecol Obstet. 1999). In contrast to ITP in nonpregnant individuals, treatment of ITP in pregnancy is limited and no consensus has been reached regarding treatment. Although corticosteroids and intravenous immunoglobulin (IVIg) are acceptable treatments for ITP in pregnancy, the evidence from large-scale clinical trials is still insufficient. Here we retrospectively analyzed the data from 5 collaborative centers in China to compare the effectiveness of corticosteroids plus IVIg with that of corticosteroids alone for the treatment of immune thrombocytopenia in pregnancy.Between January 2001 and July 2017, 521 women (572 pregnancies) were enrolled in this retrospective study. The diagnosis of ITP was confirmed in women previously diagnosed with ITP. Patients whose platelet counts remained above 70×109/L during pregnancy and normalized in the postpartum period were deemed to have gestational thrombocytopenia and were excluded (Sun D, et al. Blood 2016). The median initial prednisone dose was 15 mg/d (interquartile range [IQR] 10-30 mg/d) in both the combined therapy group and the monotherapy group. IVIg was given concomitantly at a daily dose of 20g during the first 3-5 days in the combined therapy group. Another 3 cycles of IVIg were given every 2-4 weeks if maternal platelet response was observed (platelets ≥30×109/L). Withdrawal of IVIg could be performed when platelets rose above 300×109/L in <14 days. A total of 2 cycles of IVIg could be given for no platelet response (platelets <30×109/L).The intervention was not introduced in 340 pregnancies (340/572, 59%). Among the remaining 232 women with pregnancies, 105 (45%) were given prednisone plus IVIg as the initial treatment and 127 were given only prednisone. The maternal characteristics, including age, maternal pretreatment platelet count, bleeding score and more, did not differ between the two groups. No differences between the two groups were observed with regard to the maternal response to the initial treatment (including complete response [CR] and partial response [PR], prednisone plus IVIg 48% vs. prednisone 36%, p=0.08), nor were differences observed with regard to the proportion of maternal complications, including bleeding episodes in the antenatal period, platelet count at delivery, pre-delivery platelet transfusion, mode of delivery (vaginal delivery or cesarean section), abortion and premature delivery. For patients with an initial response, there was a significant difference between the time to response (TTR) of the corticosteroids plus IVIg group (median and range, 3 and 1-14 days) and the TTR of the corticosteroid group (7 and 2-18 days) (p <0.01). Notably, 62 of 81 pregnancies with no response to prednisone were given IVIg, and the response to the treatment was 34% (21/62). Moreover, of 324 women (357 pregnancies) with a history of ITP, the majority of pregnancies (255/357, 71%) did not require treatment. A review of 197 women (215 pregnancies) with newly diagnosed ITP during pregnancy revealed that most ITP (161/215, 74.8%) was first recognized in the first trimester. With regard to the neonatal characteristics, 599 neonates (572 pregnancies) were live births and none were intrauterine death. Among 389 neonates (389/599, 65%) whose cord blood platelet counts were measured, platelet counts<100×109/L were observed in 118/389 (30%) neonates, and specifically in 18/155 neonates (12%) whose mothers were not treated. No fatal or severe neonatal hemorrhage was observed. The proportion of neonates with an Apgar score <7 at 5 minutes and neonatal platelet counts at birth did not differ between the groups. Neonatal cord platelet count compared with maternal platelet count at delivery indicated a lack of linear relation. Adverse events, including hyperglycemia requiring treatment, infection, and others, were reported in 19/105 (18%) of the prednisone plus IVIg group and in 31/127 (24%) of the prednisone group (p=0.28).In conclusion, no better maternal platelet count response but a shorter TTR were shown in the prednisone plus IVIg group compared with the prednisone group in this observational study of ITP patients in pregnancy. Prospective studies are needed to better identify the effectiveness and safety of these regimens and to explore new therapeutic options. DisclosuresNo relevant conflicts of interest to declare.