title: Thrombocytopenia and platelet transfusion in the neonate.
abstract: Neonatal thrombocytopenia is widespread in preterm and term neonates admitted to neonatal intensive care units, with up to one-third of infants demonstrating platelet counts <150 × 10(9)/L. Thrombocytopenia may arise from maternal, placental or fetal/neonatal origins featuring decreased platelet production, increased consumption, or both mechanisms. Over the past years, innovations in managing neonatal thrombocytopenia were achieved from prospectively obtained clinical data on thrombocytopenia and bleeding events, animal studies on platelet life span and production rate and clinical use of fully automated measurement of reticulated platelets (immature platelet fraction). This review summarizes the pathophysiology of neonatal thrombocytopenia, current management including platelet transfusion thresholds and recent developments in megakaryopoietic agents. Furthermore, we propose a novel index score for bleeding risk in thrombocytopenic neonates to facilitate clinician's decision-making when to transfuse platelets.
authors.affiliation: Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany. Electronic address: malte.cremer@charite.de.
authors.forename: Malte
authors.initials: M
authors.lastname: Cremer
authors.affiliation: Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Sallmon
authors.affiliation: Department of Pediatrics, University of Wisconsin - Madison, Madison, WI, USA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Kling
authors.affiliation: Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
authors.affiliation: Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Dame
mesh_terms: D001565:Benzoates / Q000627:therapeutic use; D000066491:Clinical Decision-Making; D006401:Hematologic Agents / Q000627:therapeutic use; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D017713:Platelet Transfusion / Q000379:methods / Q000592:standards; D011720:Pyrazoles / Q000627:therapeutic use; D011961:Receptors, Fc / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D034061:Thrombopoiesis / Q000502:physiology; D013926:Thrombopoietin / Q000627:therapeutic use
chemical_list: D001565:Benzoates; D006401:Hematologic Agents; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag
keywords: Bleeding index; Hemorrhage; Immature platelets; Megakaryopoiesis; Platelet function; Preterm; Reticulated platelets