We have previously demonstrated that, as compared to adults, the platelets of VLBW neonates are markedly hyporeactive on day 0 - 1 of life. In this study, we examined the age dependency of this hyporeactivity. On days 0 - 1, 3- 4, and 10 - 14, peripheral blood was collected from 9 stable VLBW neonates(birth weight <1 kg, gestation <29 weeks) and compared to peripheral blood from normal adults run in parallel. To circumvent methodologic problems, we used a whole blood flow cytometric method to examine the activation-dependent increase in platelet surface P-selectin (reflectingα granule secretion) and decrease in platelet surface glycoprotein (GP) Ib (the von Willebrand factor receptor), in response to either thrombin 2 U/mL, U46619 10 μM (a stable thromboxane A2 analogue), or ADP 20μM with epinephrine 20 μM. In addition, we used a whole blood flow cytometric method to examine the activation-dependent generation of procoagulant activity (as reported by a monoclonal antibody to activated coagulation factor V) on platelets and platelet-derived microparticles, in response to either the calcium ionophore A23187 80 μM with CaCl2 3 mM or a combination of thrombin 2 U/mL, collagen 10 μg/mL, and CaCl2 3 mM. On day 0 - 1, VLBW neonatal platelets were less reactive than adult platelets to thrombin, U46619, and ADP/epinephrine, as determined by the extent of increase in platelet surface P-selectin, decrease in platelet surface GPIb, and generation of procoagulant activity. On days 3 - 4, this hyporeactivity was even more marked. However, on day 10 - 14, the platelets of VLBW neonates were almost as reactive as adult platelets. In summary, in the physiologic milieu of whole blood, as determined by the increase in platelet surface P-selectin, decrease in platelet surface GPIb, and generation of procoagulant activity, the platelets of VLBW neonates are maximally hyporeactive (compared to adult platelets) on days 3 - 4, but return to almost the adult range by days 10 - 14. Given that IVH is also maximal on days 3 - 4, these defects may contribute to the propensity of VLBW neonates to IVH.
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