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 Vol. 10 No. 9, September 2009
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NeoReviews Vol.10 No.9 2009 e435
© 2009 American Academy of Pediatrics

Thrombocytopenia in the Neonatal Intensive Care Unit

Matthew A. Saxonhouse, MD*
Martha C. Sola-Visner, MD{dagger}

* Assistant Professor, Division of Neonatology, Department of Pediatrics, University of Florida, College of Medicine, Gainesville, Fla
{dagger} Assistant Professor of Pediatrics, Division of Newborn Medicine, Children's Hospital Boston and Harvard University School of Medicine, Boston, Mass

As the survival of neonates cared for in the neonatal intensive care unit (NICU) has improved, hematologic issues have been recognized as clinically significant problems in this population. Thrombocytopenia, in particular, is a common finding among sick neonates, but there is considerable debate regarding the appropriate evaluation and management of affected infants. This article provides state-of-the art information on the pathophysiology, diagnosis, and treatment of neonatal thrombocytopenia. Specifically, the risks associated with low platelet counts in neonates are discussed, and a practical approach to the differential diagnosis of neonates who develop thrombocytopenia is provided. Current recommendations for the management of immune and nonimmune varieties of thrombocytopenia also are reviewed, with an emphasis on the risks and benefits associated with platelet transfusions in this age group.

Abbreviations: CMV: cytomegalovirus • ELBW: extremely low birthweight • GA: gestational age • GVHD: graft versus host disease • HPA: human platelet antigen • MPV: mean platelet volume • IPF: immature platelet fraction • ITP: immune thrombocytopenic purpura • IVIG: intravenous immune globulin • NAIT: neonatal alloimmune thrombocytopenia • NICU: neonatal intensive care unit • RP%: reticulated platelet percentages • Tpo: thrombopoietin • vWF: von Willebrand


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