THROMBOCYTOPENIA IN THE NEONATE
Section snippets
Platelet Production
Although the complete details of platelet production from megakar- yocles have not been elucidated, megakaryocyle prognitors at various stages of differentiation can be identified though in vitro assays of megakaryocle burst forming and colony-forming units26, 77 The growth of these megakaryocyte progenitor cells in vitro can be supported by several recombinant human hematopoietic growth factors, in particular interleukin 3. Recently, thrombopoietin(TPO), a cytokine more specific for
DIFFERENTIAL DIAGNOSIS OF THROMBOCYTOPENIA IN NEONATES
The differential diagnosis of neonatal thrombocytopenia may be characterized broadly according to those entities resulting from increased platelet destruction, decreased platelet production, mixed destruction and production, or to mixed or unknown pathogenesis. In large series, thrombocytopenia in sick neonates is most often found to be secondary to increased platelet destruction, as evidenced by decreased111In Oxine-labeled platelet survival, increased MPV, normal or increased numbers of bone
APPROACH TO THROMBOCYTOPENIC NEONATES
The approach to thrombocytopenic infants varies according to whether the infant seems well or sick. Because the majority of thrombocytopenias are secondary to other disease processes, a careful birth history must include associated disorders, such as hypoxia, infection, and maternal illness. In addition, a family history should be obtained with particular attention to maternal thrombocytopenia, maternal medications, other cytopenias, skeletal anomalies, and thrombocytopenia in previous infants.
Rationale for Treatment
Treatment of neonatal thrombocytopenia is based on the assumption that low platelet counts pose a significant risk to the infant and that increasing the count decreases that risk. As previously mentioned, most (but not all) studies indicate that the risk of life-threatening hemorrhage is increased when the platelet count is low. Because the majority of neonatal thrombocytopenias are secondary to other disease processes, control of the underlying disorder is the most important step. Although no
SUMMARY
Pediatricians caring for newborns will eventually be confronted with the problem of thrombocytopenia in the neonatal period. Familiarity with the differential diagnosis of neonatal thrombocytopenia and understanding the pathogenesis of the more common entities allows physicians to design a selective diagnostic and therapeutic plan to benefit these thrombocytopenic infants.
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Cited by (34)
A founder mutation in the MPL gene causes congenital amegakaryocytic thrombocytopenia (CAMT) in the Ashkenazi Jewish population
2011, Blood Cells, Molecules, and DiseasesCitation Excerpt :We therefore calculate that the presence of all six MPL-associated polymorphisms present on the c.79 + 2T > A-bearing allele is a rare event and occurs in at most 0.4% of individuals of the AJ descent who do not carry the c.79 + 2T > A mutation. Thrombocytopenia is a common clinical problem observed in neonates and can be due to placental insufficiency, a congenital infection or an autoimmune or alloimmune response [28–31]. CAMT, which is caused by the homozygous or compound heterozygous presence of mutations in the thrombopoietin receptor-encoding gene, MPL, is viewed as a rare cause of thrombocytopenia in a neonate.
Platelet Transfusions in the Infant and Child
2004, Handbook of Pediatric Transfusion MedicinePathophysiology of Bleeding Disorders in the Newborn
2003, Fetal and Neonatal Physiology: Third EditionNeonatal hemorrhagic syndromes
2001, Archives de PediatrieThrombopoietin in the fetus and neonate
2000, Early Human DevelopmentMaternal causes of perinatal thrombocytopenia
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Address reprints request to Alan Homans, MD, Department of Pediatrics Given A121, University of Vermont College of Medicine, Burlington, VT 05405
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From the Department of Pediatrics, University of Vermont College of Medicine, Bur lington, Vermont