Neonatal thrombocytopenia

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  • 1. Dr. Shantanu2nd Yr DNB,DEPT OF PEDIATRICSJ.L.N.Hospital & Research centre,Bhilai Steel Plant
  • 2. WHAT WHAT ARE THE TOPICS? Definition and classification Causes APPROACH TO NEONATAL THROMBOCYTOPENIAS NAIT GUIDELINE FOR PLATELET TRANSFUSION IN NICU
  • 3.  Thrombocytopenia in neonates is traditionally difined as a platelet count <150000/mcL OveralI ncidence of neonatal thrombocytopenia is (0.7%–0.9%) In Neonatal Intensive Care Unit (NICU) it is very high (22%–35%)
  • 4. Mild- (PC = 100000 – 150000/mcl)Moderate (PC = 50000 – 99000/mcl)Severe (PC < 50000/mcl)
  • 5. CONDITIONFetal Alloimmune condition Congenital infection (e.g., CMV, toxoplasma, rubella, HIV) Aneuploidy (e.g., trisomy 18,13, or 21, or triploidy) Autoimmune condition (e.g., ITP, SLE) Severe Rh hemolytic disease Congenital/inherited (e.g., Wiskott- Aldrich syndrome)
  • 6. CONDITIONEarly-onset Placental insufficiency (e.g., PET, IUGR, diabetes)neonatal (<72hr) Perinatal asphyxia Perinatal infection (e.g., Escherichia coli, GBS, Haemophilus influenzae), DIC Alloimmune condition Autoimmune condition (e.g., ITP, SLE) Congenital infection (e.g., CMV, toxoplasma, rubella, HIV) Thrombosis (e.g., aortic, renal vein) Bone marrow replacement (e.g., congenital leukemia) Kasabach-Merritt syndrome Metabolic disease (e.g., proprionic and methylmalonic acidemia) Congenital/inherited (e.g., TAR, CAMT)
  • 7. Late-onset Late-onset sepsisneonatal (>72 hr) NEC Congenital infection (e.g., CMV, toxoplasma, rubella, HIV) Autoimmune Kasabach-Merritt syndrome Metabolic disease (e.g., proprionic and methylmalonic acidemia) Congenital/inherited (e.g., TAR, CAMT
  • 8. Early-onset thrombocytopenia (<72 hr) MILD TO SEVERE MODERATE PC <50000 (PC 50000 - 149000) Next slde -BABY WELL -EVIDENCE OF PLACENTAL -BABY ILL INSUFFICIENCY - NO EVIDENCE OF PLACENTAL INSUFFICIENCY Pc raising pc n by 10 days Evaluate sepsis , dic No further evaluation Evidence of sepsis.DIC pc No evidence ofPc not raising >with Tt sepsis,DIC persistentpc not n by 10 thrombocytopenias days No further evaluation Motherwith <pc Mother with <pc pe s/oTAR PRUS trisomy13,18, 2 pe s/o TAR PRUS 1 trisomy 18, 21,13 noonan, Turnar turnar, Noonan syndrome syn
  • 9. Severe (PC <50000) Evaluate for sepsis , DIC , NAIT Evidence of sepsis,DIC,NAITNo sepsis,DIC, NAIT Persistent PC improved with Tt thombocytopenias No further evaluation Mother <PC Pe s/oTAR PRUS trisomy 18, 21,13 Noonan, Turnar syn
  • 10. Mother <PC Pe s/oTAR PRUS trisomy 18, 21,13 Noonan, Turnar syn Yes to any q:If no to all questions, consider: confirmatory TORCH infections Viral test infections (HIV, enterovirus) Chromosomal abnormalities Inborn errors of metabolism Thrombosis (i.e., RVT)Congenital thrombocytopenias
  • 11. Late-onset Thrombocytopenia Evaluate for sepsis , NEC Evidence of No Evidence of sepsis,NEC sepsis,NECPC normal with Tt • DIC Viral infection (i.e., HSV, acquired CMV) Thrombosis (especially if central line present) No further drug-induced thrombocytopenia evaluation inborn errors of metabolism Fanconi anemia
  • 12.  Immune thrombocytopenia occurs due to the passive transfer of antibodies from the maternal to the fetal circulation. Types: 1) Neonatal alloimmune thrombocytopenia (NAIT) 2) Autoimmune thrombocytopenia
  • 13.  The antibody is produced in the mother against a specific human platelet antigen (HPA) present in the fetus but absent in the mother. The antigen is inherited from the father of the fetus. Early onset severe thrombocytopenia. The combination of severe neonatal thrombocytopenia with a parenchymal (rather than intraventricular) intracranial hemorrhage is highly suggestive of NAIT.
  • 14.  Investigation : 1)Antigen screening (HPA 1,3,5,9,15,4) 2)Brain imaging studies Management: 1) Suspected NAIT in an unknown pregnancy 2) Known case of NAIT 3)Antenatal management of pregnant woman with previous history of NAIT
  • 15.  Management of the neonate with suspected NAIT in an unknown pregnancy. 1) Random-donor platelet transfusion 2)IVIG (1g/kg/day for 2 days) 3) Antigen-negative platelet transfusion 4) Methylprednisolone (1 mg/kg bid for 3–5 days) Management of the neonate with known NAIT Antigen-negative platelet transfusion Antenatal management of pregnant women with previous history of NAIT IVIG to mother
  • 16. Platelet Count (*10000mcl)<30 Transfuse all30-49 Transfuse if: • BW <1,500g and & 7 days old • Clinically unstable • Concurrent coagulopathy • Previous significant hemorrhage (i.e., grade 3 or 4 IVH) • Prior to surgical procedure • Postoperative period (72 hours)50–100 Transfuse if: • Active bleeding • NAIT with intracranial bleed • Before or after neurosurgical procedures
  • 17.  Dose: 10 -15 ml/kg Complications: Transfusion-transmitted CMV infections Graft-versus-host disease (GVHD) TRALI
  • 18. THANK YOU