Abstract :
Neonatal Thrombocytopenia is a common Problem in NICU. Platelets are produced by megakaryopoiesis and Thrombopoiesis is bone marrow in adults but in neonates Liver and Placenta are the other probable sites. Platelets appear in foetal circulation at 5 weeks of gestation and reach the adult count by 2nd trimester of Pregnancy. Tpo and Interleukin-ll are important stimulator for megakaryocytes. Normally thrombocytopenia occurs in 1-5% of Newborns, with severe thrombocytopenia in 0.1-0.5%. Neonatal Thrombocytopenia is the result of impaired Platelet production, increased Platelet destruction and sequestration or the combination of both. Increase platelet destruction can be immune mediated or non immune, associated with other diseases. Immune mediated thrombocytopenia can be neonatal Alloimmune thrombocytopenia (NAIT), Auto immune thrombocytopenia or due to maternal antiplatelet antibodies. The early onset Neonatal thrombocytopenia occurs within 72 hours and late onset after 72 hours with high risk of IVH. Thrombocytopenia is a risk factor for ICH (Intracranial Haemorrhage). IVH is more common in VLBW (Very low birth weight) infants and most are due to immune mediated Thrombocytopenia. History and clinical features are mostly over shadowed by the disease causing Thrombocytopenia. Platelet count is the mainstay of diagnosis. In Alloimmune Thrombocytopenia platelet antigen typing of father, mother and the baby is necessary. With a count below 30000/µlt. HPA (Human Platelet Antigen) compatible platelets is to be administered. In unstable eonates and with active bleeding it can be transfused below 50000/µlt. With a count of below 30000/µlt IVIg may be given regardless of bleeding.
Keyword :
Neonatal Thrombocytopenia, NICU, Megakaryopoiesis, Thrombopoiesis, Tpo (thrombopoetin), Interleukin-ll, NAIT (Neonatal Alloimmune Thrombocytopenia), ICH (Intracranial Haemorrhage), IVH (Intra Venticular Haemorrhage), HPA (Human Platelet Antigen), IVIg (In