1
|
Tomicic M, Sotonica Piria T, Bingulac-Popovic J, Babic I, Stimac R, Vuk T. Transient pseudothrombocytopenia (PTCP) in the neonate due to the mother. Transfus Clin Biol 2022; 29:257-260. [PMID: 35718061 DOI: 10.1016/j.tracli.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
Thrombocytopenia with platelet count <50×109/L is common laboratory finding in a severely ill newborn in neonatal intensive care units (ICU). Neonates with severe thrombocytopenia are at risk of bleeding. Most dangerous is intracerebral hemorrhage (ICH) frequently leading to death or lifelong neurological sequels. Pseudothrombocytopenia (PTCP) is a rare in vitro phenomenon of falsely low platelet count determined on hematology analyzers due to platelet clumping in ethylenediaminetetraacetic acid (EDTA) anticoagulated blood. PTCP was also reported in pregnant women with isolated thrombocytopenia. EDTA-PTCP in the neonate due to the transplacental transmission of maternal antibodies has been reported only in a few cases. Although PTCP is rare phenomenon, it should always be excluded in newborns with isolated thrombocytopenia to avoid erroneous interpretation of platelet and leukocyte count, unnecessary laboratory investigation of false positive antiplatelet antibodies and needless platelet transfusions. We report on two cases of transient PTCP in a neonate due to transplacental transfer of maternal EDTA-dependent autoantibodies of IgG class from the same mother.
Collapse
Affiliation(s)
- M Tomicic
- Department of Platelet and Leukocyte Diagnostics and Hemostasis, Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
| | - T Sotonica Piria
- Department of Pediatrics, Department of Gynecology and Obstetrics, Virovitica General Hospital, Virovitica, Croatia
| | - J Bingulac-Popovic
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - I Babic
- Department of Molecular Diagnostics, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - R Stimac
- Quality management department, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - T Vuk
- Quality management department, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| |
Collapse
|
2
|
Lardinois B, Favresse J, Chatelain B, Lippi G, Mullier F. Pseudothrombocytopenia-A Review on Causes, Occurrence and Clinical Implications. J Clin Med 2021; 10:594. [PMID: 33557431 PMCID: PMC7915523 DOI: 10.3390/jcm10040594] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Pseudothrombocytopenia (PTCP), a relative common finding in clinical laboratories, can lead to diagnostic errors, overtreatment, and further (even invasive) unnecessary testing. Clinical consequences with potential life-threatening events (e.g., unnecessary platelet transfusion, inappropriate treatment including splenectomy or corticosteroids) are still observed when PTCP is not readily detected. The phenomenon is even more complex when occurring with different anticoagulants. In this review we present a case of multi-anticoagulant PTCP, where we studied different parameters including temperature, amikacin supplementation, measurement methods, and type of anticoagulant. Prevalence, clinical risk factors, pre-analytical and analytical factors, along with clinical implications, will be discussed. The detection of an anticoagulant-dependent PTCP does not necessarily imply the presence of specific disorders. Conversely, the incidence of PTCP seems higher in patients receiving low molecular weight heparin, during hospitalization, or in men aged 50 years or older. New analytical technologies, such as fluorescence or optical platelet counting, will be soon overturning traditional algorithms and represent valuable diagnostic aids. A practical laboratory approach, based on current knowledge of PTCP, is finally proposed for overcoming spuriously low platelet counts.
Collapse
Affiliation(s)
- Benjamin Lardinois
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
| | - Julien Favresse
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
| | - Bernard Chatelain
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy;
| | - François Mullier
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
| |
Collapse
|
3
|
|
4
|
Christensen RD, Baer VL, Henry E, Snow GL, Butler A, Sola-Visner MC. Thrombocytopenia in Small-for-Gestational-Age Infants. Pediatrics 2015; 136. [PMID: 26216323 PMCID: PMC4906543 DOI: 10.1542/peds.2014-4182] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Thrombocytopenia is common among small-for-gestational-age (SGA) neonates (birth weight <10th percentile reference range), but several aspects of this thrombocytopenia are unclear, including the incidence, typical nadir, duration, association with preeclampsia, mechanism, and risk of death. METHODS Using 9 years of multihospital records, we studied SGA neonates with ≥2 platelet counts <150,000/μL in their first week. RESULTS We found first-week thrombocytopenia in 31% (905 of 2891) of SGA neonates versus 10% of non-SGA matched controls (P < .0001). Of the 905, 102 had a recognized cause of thrombocytopenia (disseminated intravascular coagulation, early-onset sepsis, or extracorporeal membrane oxygenation). This group had a 65% mortality rate. The remaining 803 did not have an obvious cause for their thrombocytopenia, and we called this "thrombocytopenia of SGA." They had a mortality rate of 2% (P < .0001) and a mean nadir count on day 4 of 93,000/μL (SD 51,580/μL, 10th percentile 50,000/μL, 90th percentile 175,000/μL). By day 14, platelet counts were ≥150,000/μL in more than half of the patients. Severely SGA neonates (<1st percentile) had lower counts and longer thrombocytopenia duration (P < .001). High nucleated red cell counts at birth correlated with low platelets (P < .0001). Platelet transfusions were given to 23%, and counts typically more than tripled. Thrombocytopenia was more associated with SGA status than with the diagnosis of maternal preeclampsia. CONCLUSIONS SGA neonates with clearly recognized varieties of thrombocytopenia have a high mortality rate. In contrast, thrombocytopenia of SGA is a hyporegenerative condition of moderate severity and 2 weeks' duration and is associated with evidence of intrauterine hypoxia and a low mortality rate.
Collapse
Affiliation(s)
- Robert D. Christensen
- Divisions of Hematology/Oncology, and,Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;,Primary Children’s Hospital, Salt Lake City, Utah;,Address correspondence to Robert D. Christensen, MD, University of Utah Department of Pediatrics, 295 Chipeta Way, Salt Lake City, UT 84108. E-mail:
| | - Vickie L. Baer
- Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Erick Henry
- Primary Children’s Hospital, Salt Lake City, Utah
| | - Gregory L. Snow
- Statistical Data Center, LDS Hospital, Salt Lake City, Utah; and
| | - Allison Butler
- Statistical Data Center, LDS Hospital, Salt Lake City, Utah; and
| | - Martha C. Sola-Visner
- Division of Neonatal Medicine, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
Zisk JL, Mackley A, Clearly G, Chang E, Christensen RD, Paul DA. Transfusing neonates based on platelet count vs. platelet mass: A randomized feasibility-pilot study. Platelets 2013; 25:513-6. [DOI: 10.3109/09537104.2013.843072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
6
|
|
7
|
Ruiz López JJ, Rosado Caracena R, Sanabria Carretero P, Goldman Tarlovsky L. [Ethylenediaminetetraacetic-acid-dependent pseudothrombocytopenia]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:119-120. [PMID: 19334662 DOI: 10.1016/s0034-9356(09)70343-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
8
|
Slayton WB, Patel M, Sola-Visner M, Harris N, Rivers A, Montgomery RR, Friedman KD. Type 2B von Willebrand disease associated with the release of platelet agglutinates from megakaryocytes in the bone marrow. J Pediatr Hematol Oncol 2008; 30:708-11. [PMID: 18776767 PMCID: PMC5592795 DOI: 10.1097/mph.0b013e31817541cd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a child with thrombocytopenia since birth, circulating platelet agglutinates, and a tendency to bleed. A bone marrow aspirate revealed large platelet clumps within the bone marrow and megakaryocyte nuclei surrounded by halos of clumped platelets. Laboratory evaluation revealed type 2B von Willebrand disease. Gene sequencing revealed a G to C mutation at base 3923 of the VWF gene. This mutation was previously described in a family with circulating platelet clumps and abnormal megakaryopoiesis with release of clumped platelets in culture. This same mutation was previously described in a family with circulating platelet aggregates and abnormalities of platelet release from megakaryocytes in vitro. Presence of megakaryocytes with halos of clumped platelets in our patient suggests that platelet agglutinate occurs in the bone marrow in some type 2B von Willebrand disease patients.
Collapse
|
9
|
Abstract
Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal antibodies are directed against antigens on fetal and paternal but not maternal platelets. Most cases of NAIT arise when platelets of the father (and the fetus) express the human platelet antigen (HPA)1a and the mother's platelets expresses HPA-1b. A female patient presented with congenital severe thrombocytopenia and received 4 platelet transfusions, on days 2, 7, 16, and 28. This appeared to be a case of NAIT; however, extensive serologic evaluation by 2 reference laboratories failed to reveal the offending platelet antigen. Consistent with NAIT, the condition resolved by 6 weeks of age. By patient day of life 42, the platelet count had increased without additional need for transfusions, and by 16 weeks, the patient had a completely normal platelet count of 437,000/microL. The patient's platelet count remains normal at a 2-year follow-up. This case is reported as an instructive atypical case of NAIT, in which the relevant platelet antigen could not be identified.
Collapse
Affiliation(s)
- Cindy K Barney
- Neonatal Intensive Care Unit, McKay-Dee Hospital, Intermountain Health Care, 4401 Harrison Boulevard, Ogden, UT 84403, USA.
| | | | | |
Collapse
|
10
|
|
11
|
Roberts IA, Murray NA. Thrombocytopenia in the Newborn. Platelets 2007. [DOI: 10.1016/b978-012369367-9/50814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Christensen RD, Henry E, Wiedmeier SE, Stoddard RA, Sola-Visner MC, Lambert DK, Kiehn TI, Ainsworth S. Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system. J Perinatol 2006; 26:348-53. [PMID: 16642027 DOI: 10.1038/sj.jp.7211509] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Thrombocytopenia is common in neonatal intensive care units (NICU), with 18 to 35% of patients developing this problem before hospital discharge. It might be even more common among extremely low birth weight neonates (ELBW, < or = 1000 g birth weight). However, little is known about thrombocytopenia in the ELBW population. We sought to determine the incidence, timing, causes, platelet transfusions given, and outcomes of thrombocytopenia among ELBW neonates. STUDY DESIGN We performed a cohort analysis of all 284 ELBW neonates born during 2003 and 2004 cared for in any of the Intermountain Healthcare level III NICUs. RESULTS Multiple platelet counts were obtained in all 284 (range, 4 to 441 platelet counts/patient). Of the 284, 208 (73%) had one or more platelet counts < or =150 000/microl. Most were detected during the first days of life; 80% were detected during the first week and only 20% were detected thereafter. Thrombcytopenia was more common among the smallest patients; 85% incidence among those < or =800 g, 60% among those 801 to 900 g, and 53% among those 901 to 1000 g. Platelet transfusions were given to 129 of the 208 thrombocytopenic neonates. More than 90% were given prophylactically (the patient was not bleeding). The mortality rate among those that received platelet transfusions was twice that of those that received no platelet transfusions (P < 0.01). In 48% of cases, the cause of the thrombocytopenia went undiagnosed. The most common explanations were being small for gestational age or delivered to a hypertensive mother, DIC, bacterial infection, fungal infection, and necrotizing enterocolitis, respectively. CONCLUSIONS We observed thrombocytopenia among ELBW neonates at a rate more than twice that reported among the general NICU population. Much remains to be discovered about the etiology and best treatments of thrombocytopenia among ELBW neonates.
Collapse
Affiliation(s)
- R D Christensen
- Intermountain Healthcare Clinical Research, McKay-Dee Hospital Center, Ogden, UT 84403, USA.
| | | | | | | | | | | | | | | |
Collapse
|