Predictive Factors for Severe Thrombocytopenia and Classification of Causes of Thrombocytopenia in Premature Infants

Hoon Bum Shin,Na Li Yu,이나미,이대용,윤신원,채수안,임인석 대한신생아학회 2018 Neonatal medicine Vol.25 No.1

Purpose: This study investigated predictive factors for severe neonatal thrombocytopenia, which greatly increases the need for intensive care and is associated with a high mortality rate in premature infants. Factors adopted for prompt identification of at-risk newborns include blood test results and birth history. This study analyzed the relationship between the presence of severe neonatal thrombocytopenia and the mortality rate. The causes of thrombocytopenia in premature infants were also examined. Methods: This retrospective study evaluated 625 premature infants admitted to the neonatal intensive care unit (NICU) at Chung-Ang University Medical Center. The neonates were classified into 3 groups according to the severity of thrombocytopenia: mild (100×109/L≤platelet<150×109/L), moderate (50×109/L≤platelet<100×109/L), or severe (platelet<50×109/L). Analysis of blood samples obtained at the onset of thrombocytopenia included platelet count, white blood cell (WBC) count, hemoglobin level, hematocrit level, absolute neutrophil count, and high-sensitivity C-reactive protein level. Results: Of the 625 premature infants admitted to our NICU, 214 were detected with thrombocytopenia. The mortality rate in thrombocytopenic neonates was 18.2% (39/ 214), whereas a mortality rate of only 1.0% was observed in non-thrombocytopenic neonates. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants. Severe thrombocytopenia was noted more frequently in premature infants with higher WBC counts and in those with a younger gestational age. Conclusion: Platelet count, WBC count, and gestational age are reliable predictors for severe neonatal thrombocytopenia. The major causes of thrombocytopenia were perinatal insufficiency and sepsis in premature infants.

Tocilizumab-induced Thrombocytopenia in Patients with Rheumatoid Arthritis

( Jung Sun Lee ),( Ji Seon Oh ),( Seokchan Hong ),( Chang-keun Lee ),( Bin Yoo ),( Yong-gil Kim ) 대한류마티스학회 2019 대한류마티스학회지 Vol.26 No.3

Objective. Interlukin-6 (IL-6) increases platelet count during inflammation and may act in a manner similar to thrombopoietin. Tocilizumab is a monoclonal antibody of the IL-6 receptor and widely used in the treatment of rheumatoid arthritis (RA). Here, we evaluated the incidence of tocilizumab-induced thrombocytopenia and clinical factors associated with the development of thrombocytopenia. Methods. Patients with RA, who were treated with tocilizumab and had exposed to other biologics previously in a tertiary hospital between January 2014 and December 2017, were retrospectively evaluated. We compared occurrence of thrombocytopenia between tocilizumab and previous biologics. Furthermore, the factors associated with thrombocytopenia were analyzed using logistic regression analysis. Results. In total, 114 patients with RA were treated with tocilizumab for mean 90.5 weeks (interquartile range, 30.9∼174.9). Thrombocytopenia was reported in 14 patients (12.3%) and it was higher rate compared with previous biologics. Most cases were grade 1 thrombocytopenia. Multivariate analysis showed that patient age (odds ratio [OR], 2.170; 95% confidence interval [CI], 1.118∼4.211; p=0.022) and platelet count prior to treatment with tocilizumab (OR, 0.972; 95% CI, 0.954∼0.990; p=0.002) were significantly associated with the development of thrombocytopenia. Conclusion. Old age is risk factor for developing tocilizumab-induced thrombocytopenia and higher platelet count prior to treatment is associated with lowering risk of development of thrombocytopenia. However, thrombocytopenia was tolerable. (J Rheum Dis 2019;26:186-190)

임상 ; 초극소저체중출생아의 조기 발생 혈소판 감소증의 위험인자 및 예후에 관한 고찰

김희섭 ( Hee Sup Kim ),김도현 ( Do Hyun Kim ),이정하 ( Jung Ha Lee ),최장환 ( Jang Hwan Choi ),안영석 ( Young Seok An ),김인욱 ( In Uk Kim ) 대한주산의학회 2012 Perinatology Vol.23 No.4

목적 : 혈소판 감소증은 신생아 집중 치료실에서 흔히 볼 수 있는 혈액 이상증이다. 하지만 초극소저체중출생아에서의 혈소판 감소증에 대해서는 알려진 바가 적다. 따라서 저자들은 초극소저체중출생아에서의 혈소판 감소증의 임상 양상 및 예후에 대해서 알아보고자 본 연구를 시행하였다. 방법 : 2006년 1월부터 2010년 12월까지 동국대학교 일산병원에서 출생하여 신생아 집중 치료실에 입원한 재태 연령 32주 미만, 출생 체중 1,000 g 미만인 환자 중 출생 후 48시간 내에 사망한 환자들을 제외한 88명을 최종 대상으로 전자 의무기록을 통한 후향적 연구를 시행하였다. 혈소판 감소증은 혈중 혈소판 수치가 150×109/L이하를 기준으로 하였으 며 해당 환자 중 혈소판 감소증이 출생 후 72시간 이내에 발생한 조기발병 혈소판 감소증 군(A군)과 조기 발병 혈소판 감소증이 없었던 군(B군)으로 나누어 두 군 간에 산모 및 환자의 임상적 특징 및 사망률, 합병증에 대해서 분석하였다. 결과 : 전체 88명의 환자 중 입원기간 내에 한 차례 이상의 혈소판 감소증이 관찰된 환자는 82명(93.2%)이었다. 출생 후 3일 이내에 49명(59.7%), 출생 후 일주일 이내에 71명(86.6%)의 환자에서 혈소판 감소증이 관찰 되었으며 출생 체중이 작을수록 더 많은 혈소판 감소증이 관찰되었다. 약 절반에 해당하는 환자에서는 혈소판 감소증의 원인을 명확히 알 수 없었으며 사망률(P=0.010), 신생아 호흡곤란 증후군(P=0.006), Grade 2 이상의 뇌실 내 출혈(P=0.019)은 A군에서 유의 하게 높게 나타났다. 조기 발병 혈소판 감소증의 사망률에 대한 위험도를 알아보기 위해 로지스틱 회귀분석을 시행하였 으며 A군이 B군에 비해 사망에 대한 비교위험도가 3.201 (P=0.025)로 유의하게 높게 나타났다. 결론 : 초극소저체중출생아에서의 혈소판 감소증의 유병률은 90% 이상으로 높게 나타났으며 약 절반에서 그 원인을 명확히 알 수 없었고, 사망률 및 대표적인 초기 합병증인 신생아 호흡곤란 증후군과 뇌실 내 출혈과 관련이 있는 것으로 나타났다. Purpose : Thrombocytopenia, which is common in neonatal intensive care unit (NICU), is most common among extremely low birth weight (ELBW) neonates despite recent improvement in survival of ELBW neonates. However, study of thrombocytopenia in ELBW neonates is rare and has not been studied in Korea. So we sought to determine the incidence, timing, causes, and outcome of thrombocytopenia among ELBW neonates. Methods: We retrospectively reviewed the medical records of preterm infants with gestational age <32 weeks and birth weight <1,000 g who were admitted immediately after birth to the NICU at Dongguk University Ilsan Hospital between January 2006 and December 2010. Thrombocytopenia was defined as platelet count ≤150× 109/L. The infants who had early onset thrombocytopenia comprised the study group, while remainder of infants made up the control group. The relationships between early onset thrombocytopenia and the outcomes were studied. Results : Of the 88, 82 (93.2%) had one or more platelet count ≤150×109 /L. Most were detected during the early days of life. Early onset thrombocytopenia is more common among the smallest patients and associated with respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH), which occurs few days after birth. The mortality rate was higher in study group than control group. Almost half of patients, the cause of the thrombocytopenia went undiagnosed. Conclusion : We observed high incidence of thrombocytopenia among ELBW neonates. Early onset thrombocytopenia was associated with RDS, IVH and high mortality. New efforts to improve the outcome of ELBW neonates should focus on this common problem of thrombocytopenia.

미숙아의 조기 혈소판 감소증의 원인과 신생아기 임상적 결과

이정민,이슬비,심소연,조수진,박은애 대한신생아학회 2015 Neonatal medicine Vol.22 No.3

Purpose: Thrombocytopenia is the most common hematologic abnormality diagnosed in the neonatal intensive care unit (NICU). We investigated the causes and neonatal outcomes of early-onset thrombocytopenia in preterm neonates and compared clinical outcomes between neonates in an early-onset thrombocytopenia group who have received and those who have not received platelet transfusion in order to assess the clinical significance of early-onset thrombocytopenia in preterm infants. Methods: We retrospectively reviewed the medical records of preterm neonates born earlier than 34 weeks’ gestation who were admitted to the NICU between January 2005 and September 2014. 412 preterm neonates born earlier than 34 weeks’ gestation were enrolled. The early-onset thrombocytopenia group (n=90) had a platelet count ≤150,000/mL within the first 72 hours of life. We investigated maternal and neonatal characteristics, and neonatal outcomes in the group and compared these with those of a control group (n=322). Results: The neonates with early-onset thrombocytopenia tended to have lower gestational age, birth weight and Apgar scores than controls. Maternal hypertension and lower Apgar score at birth were predictive factors of early-onset thrombocytopenia. No differences in clinical outcomes were observed between the two groups. Clinical outcomes did not significantly different between the groups regardless of whether the neonates received platelet transfusion or not. Conclusion: Early-onset thrombocytopenia had no effect on the neonatal outcomes of the preterm infants. Platelet transfusion did not affect the clinical outcomes of the neonates in the early-onset thrombocytopenia group. Thus, we suggest a lager controlled study on early-onset thrombocytopenia in newborns in order to establish more-efficient treatment guidelines.

Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period

진민지,김윤겸,최은미,심예지,김형식,서진경,김지윤,이건수,박선영,이재민,하정옥 대한혈액학회 2018 Blood Research Vol.53 No.2

Background Cytomegalovirus (CMV) causes severe diseases in premature infants and immunocompromised hosts, and antiviral therapy is often required for disease control. However, the clinical manifestations and treatment courses for CMV-associated thrombocytopenia in immunocompetent children are unclear. Methods Medical records of the children who suffered from thrombocytopenia, and showed pos-itive CMV polymerase chain reaction and CMV-like symptoms were retrospectively analyzed at three university hospitals in Daegu from January 2000 to March 2017. Patients suffering from leukemia, immunodeficiency, and other infections were excluded. Results Among 1,065 children with thrombocytopenia, 29 (2.7%) displayed CMV-associated thrombocytopenia. The median age at diagnosis was 15 months and the median platelet count was 26,000/L. They were classified into the CMV-induced thrombocytopenia (23/29) and CMV-related secondary immune thrombocytopenia (ITP, 6/29) groups. Fourteen subjects had hepatic dysfunction, four had Evans syndrome, two had pneumonitis, and one had gastritis. IVIG was used for 21 patients, and six patients among them showed recurrence, for whom IVIG or antiviral therapy was used. All, except one, re-current or chronic cases belonged to the CMV-induced thrombocytopenia group. Antiviral therapy was used more frequently for the CMV-induced thrombocytopenia group (8/23, 34.8%) than for the CMV-related secondary ITP group (0/6); however, the results were not statistically significant (P=0.148). Conclusion CMV is a rare but unique etiology of thrombocytopenia, and observed even in healthy children after the neonatal period. About one-third patients need antiviral therapy for dis-ease control. Further, CMV-induced thrombocytopenia is more complex than CMV-related secondary ITP.

Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period

진민지,김윤겸,최은미,심예지,김형식,서진경,김지윤,이건수,박선영,이재민,하정옥 대한혈액학회 2018 Blood Research Vol.53 No.2

Background Cytomegalovirus (CMV) causes severe diseases in premature infants and immunocompromised hosts, and antiviral therapy is often required for disease control. However, the clinical manifestations and treatment courses for CMV-associated thrombocytopenia in immunocompetent children are unclear. Methods Medical records of the children who suffered from thrombocytopenia, and showed pos-itive CMV polymerase chain reaction and CMV-like symptoms were retrospectively analyzed at three university hospitals in Daegu from January 2000 to March 2017. Patients suffering from leukemia, immunodeficiency, and other infections were excluded. Results Among 1,065 children with thrombocytopenia, 29 (2.7%) displayed CMV-associated thrombocytopenia. The median age at diagnosis was 15 months and the median platelet count was 26,000/L. They were classified into the CMV-induced thrombocytopenia (23/29) and CMV-related secondary immune thrombocytopenia (ITP, 6/29) groups. Fourteen subjects had hepatic dysfunction, four had Evans syndrome, two had pneumonitis, and one had gastritis. IVIG was used for 21 patients, and six patients among them showed recurrence, for whom IVIG or antiviral therapy was used. All, except one, re-current or chronic cases belonged to the CMV-induced thrombocytopenia group. Antiviral therapy was used more frequently for the CMV-induced thrombocytopenia group (8/23, 34.8%) than for the CMV-related secondary ITP group (0/6); however, the results were not statistically significant (P=0.148). Conclusion CMV is a rare but unique etiology of thrombocytopenia, and observed even in healthy children after the neonatal period. About one-third patients need antiviral therapy for dis-ease control. Further, CMV-induced thrombocytopenia is more complex than CMV-related secondary ITP.

Can we predict neonatal thrombocytopenia in offspring of women with idiopathic thrombocytopenic purpura?

Kazuhisa Hachisuga,Nobuhiro Hidaka,Yasuyuki Fujita,Kotaro Fukushima,Kiyoko Kat 대한혈액학회 2014 Blood Research Vol.49 No.4

Background We aimed to investigate which factors in the clinical profile of mothers with idiopathic thrombocytopenic purpura (ITP) can predict neonatal risk of thrombocytopenia. Methods Data was retrospectively collected from all pregnant women with ITP who presented to our institution between 2001 and 2013. Neonatal offspring of these women were classified into 2 groups based on the presence or absence of neonatal thrombocytopenia (platelet count <100×10⁹/L). Several parameters were compared between the 2 groups, including maternal age, maternal platelet count, maternal treatment history, and thrombocytopenia in siblings. We further examined the correlation between maternal platelet count at the time of delivery and neonatal platelet count at birth; we also examined the correlation between the minimum platelet counts of other children born to multiparous women. Results Sixty-six neonates from 49 mothers were enrolled in the study. Thrombocytopenia was observed in 13 (19.7%) neonates. Maternal treatment for ITP such as splenectomy did not correlate with a risk of neonatal thrombocytopenia. Sibling thrombocytopenia was more frequently observed in neonates with thrombocytopenia than in those without (7/13 vs. 4/53, P<0.01). No association was observed between maternal and neonatal platelet counts. However, the nadir neonatal platelet counts of first- and second-born siblings were highly correlated (r=0.87). Conclusion Thrombocytopenia in neonates of women with ITP cannot be predicted by maternal treatment history or platelet count. However, the presence of an older sibling with neonatal thrombocytopenia is a reliable risk factor for neonatal thrombocytopenia in subsequent pregnancies.

Can we predict neonatal thrombocytopenia in offspring of women with idiopathic thrombocytopenic purpura?

Kazuhisa Hachisuga,Nobuhiro Hidaka,Yasuyuki Fujita,Kotaro Fukushima,Kiyoko Kat 대한혈액학회 2014 Blood Research Vol.49 No.4

Background We aimed to investigate which factors in the clinical profile of mothers with idiopathic thrombocytopenic purpura (ITP) can predict neonatal risk of thrombocytopenia. Methods Data was retrospectively collected from all pregnant women with ITP who presented to our institution between 2001 and 2013. Neonatal offspring of these women were classified into 2 groups based on the presence or absence of neonatal thrombocytopenia (platelet count <100×10⁹/L). Several parameters were compared between the 2 groups, including maternal age, maternal platelet count, maternal treatment history, and thrombocytopenia in siblings. We further examined the correlation between maternal platelet count at the time of delivery and neonatal platelet count at birth; we also examined the correlation between the minimum platelet counts of other children born to multiparous women. Results Sixty-six neonates from 49 mothers were enrolled in the study. Thrombocytopenia was observed in 13 (19.7%) neonates. Maternal treatment for ITP such as splenectomy did not correlate with a risk of neonatal thrombocytopenia. Sibling thrombocytopenia was more frequently observed in neonates with thrombocytopenia than in those without (7/13 vs. 4/53, P<0.01). No association was observed between maternal and neonatal platelet counts. However, the nadir neonatal platelet counts of first- and second-born siblings were highly correlated (r=0.87). Conclusion Thrombocytopenia in neonates of women with ITP cannot be predicted by maternal treatment history or platelet count. However, the presence of an older sibling with neonatal thrombocytopenia is a reliable risk factor for neonatal thrombocytopenia in subsequent pregnancies.

정신과 입원환자에서 Valproate 유발 혈소판감소증의 발생률과 위험 요인:후향적 의무기록 조사 연구

권용길,최진희,정문용,정혜경,김태용,소형석 대한우울조울병학회 2010 우울조울병 Vol.8 No.2

Objectives:This study was conducted to investigate the incidence and risk factors of thrombocytopenia in psychiatric inpatients taking valproate. Methods:We analyzed the data of 132 patients taking valproate from electronic medical records. The incidence of thrombocytopenia was estimated, and the patients were divided into the thrombocytopenia group and the non-thrombocytopenia group. We tested the differences of demographic characteristics and clinical variables between both groups. Finally, binary logistic regression analysis was done to test the effect of potential risk factors on thrombocytopenia. Results:Fifteen (11.4%) patients experienced thrombocytopenia. The use of topiramate was associated with thrombocytopenia. The thrombocytopenia group showed lower platelet count at admission, higher level and dose of valproate compared to the non-thrombocytopenia group. Logistic regression analysis showed that the risk of thrombocytopenia substantially increased with the use of topiramate,platelet count below 200×109/L at admission, and valproate level above 100 μg/mL checked at the point of nadir platelet count. Conclusion:To reduce the risk of thrombocytopenia in psychiatric inpatients taking valproate,checking the platelet count before treatment and maintaining the level of valproate not to exceed 100 μg/mL are advised.

The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia

Sang-Hoon Kang,Min-Jun Kang 대한구강악안면외과학회 2021 대한구강악안면외과학회지 Vol.47 No.3

Objectives: The risk of bleeding after tooth extraction in thrombocytopenia patients remains unclear. Therefore, the present study aimed to assess the risk of bleeding after tooth extraction in patients with thrombocytopenia. Materials and Methods: The study included 220 patients who had a medical history of thrombocytopenia and underwent tooth extraction (330 teeth). The patients were divided into those who had thrombocytopenia (platelet count <150k) immediately before the tooth extraction, and those who had platelet counts that were between 150k and 250k before the extraction. Bleeding complications were recorded and compared between the patient groups. Results: Of the 220 patients, 130 underwent tooth extractions while having thrombocytopenia (platelet count <150k), and 90 had platelet counts that were between 150k and 250k before tooth extractions. Bleeding complications occurred in 11 patients (5.0%) of the 220 patients. Among those 11 patients with bleeding complications, 10 patients (7.7%) had thrombocytopenia (platelet count <150k) of the 130 patients, and 1 patient (1.1%) had a normal platelet count of the 90 patients. There was a significant difference between the patient groups regarding bleeding after extractions (P<0.001). No significant difference in the incidence of post-extraction bleeding was found between the subgroups by platelet count within the thrombocytopenia group. Conclusion: Thrombocytopenia (platelet count <150k) increases the risk of post-tooth extraction bleeding. Therefore, bleeding control under the proper evaluation of hemostasis and performing delicate tooth extraction procedures using hemostatic plugs is necessary during the tooth extraction of patients with thrombocytopenia.