Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2024; 23: 34-46
Тромбоцитопения новорожденных: наблюдательное исследование
https://doi.org/10.24287/1726-1708-2024-23-4-34-46Аннотация
Тромбоцитопения является частым гематологическим симптомом у новорожденных. Этиология неонатальной тромбоцитопении варьирует от распространенных приобретенных причин, таких как иммуноопосредованная тромбоцитопения и сепсис, до редких врожденных синдромов. В клинической практике могут возникнуть объективные трудности при выявлении причин тромбоцитопении у детей первого месяца жизни. Учет всех гематологических и негематологических характеристик новорожденного и членов его семьи необходим для точной верификации диагноза. В настоящей работе проанализирована когорта из 52 детей, развивших тромбоцитопению в период новорожденности, и проведена ретроспективная оценка спектра возможных клинических диагнозов. Данное исследование одобрено независимым этическим комитетом и утверждено решением ученого совета ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России. Перинатальные инфекции и сепсис часто ассоциированы с тромбоцитопенией. Иммунные формы тромбоцитопении по-прежнему остаются диагнозами исключения. В 18 (34,6%) случаях на основании проведенного молекулярно-генетического обследования были диагностированы редкие врожденные синдромы, ассоциированные с тромбоцитопенией. Несмотря на разнообразную этиологию, на практике основным методом лечения тромбоцитопении в неонатологии остается переливание донорских тромбоцитов с введением внутривенного иммуноглобулина или без него.
Список литературы
1. de Alacon P.A., Werner E. Neonatal Hematology. Cambridge University Press; 2005.
2. Donato H. Neonatal thrombocytopenia: A review. I. Definitions, differential diagnosis, causes, immune thrombocytopenia. Arch Argent Pediatr 2021; 119 (3): e202–14.
3. Donato H. Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion. Arch Argent Pediatr 2021; 119 (4): e303–14.
4. Sola-Visner M., Saxonhouse M.A., Brown R.E. Neonatal thrombocytopenia: what we do and don't know. Early Hum Dev 2008; 84 (8): 499– 506.
5. Chakravorty S., Roberts I. How I manage neonatal thrombocytopenia. Br J Haematol 2012; 156 (2): 155–62.
6. Roberts I., Murray N.A. Neonatal thrombocytopenia: causes and management. Arch Dis Child Fetal Neonatal Ed 2003; 88 (5): F359–64.
7. Gunnink S.F., Vlug R., Fijnvandraat K., van der Bom J.G., Stanworth S.J., Lopriore E. Neonatal thrombocytopenia: etiology, management and outcome. Expert Rev Hematol 2014; 7 (3): 387–95.
8. Rodeghiero F., Stasi R., Gernsheimer T., Michel M., Provan D., Arnold D.M., et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113 (11): 2386–93.
9. Patel R.M., Josephson C. Neonatal and pediatric platelet transfusions: current concepts and controversies. Curr Opin Hematol 2019; 26 (6): 466–72.
10. Peng T., Shan Y., Zhang P., Cheng G. Bleeding in neonates with severe thrombocytopenia: a retrospective cohort study. BMC Pediatr 2022; 22 (1): 730.
11. Resch E., Hinkas O., Urlesberger B., Resch B. Neonatal thrombocytopenia-causes and outcomes following platelet transfusions. Eur J Pediatr 2018; 177 (7): 1045–52.
12. Saber A.M., Aziz S.P., Almasry A.Z.E., Mahmoud R.A. Risk factors for severity of thrombocytopenia in full term infants: a single center study. Ital J Pediatr 2021; 47 (1): 7.
13. Peterson J.A., McFarland J.G., Curtis B.R., Aster R.H. Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management. Br J Haematol 2013; 161 (1): 3–14.
14. Pecci A., Balduini C.L. Inherited thrombocytopenias: an updated guide for clinicians. Blood Rev 2021; 48: 100784.
15. Stanworth S.J., Mumford A.D. How I diagnose and treat neonatal thrombocytopenia. Blood 2023; 141 (22): 2685–97.
16. Butros L.J., Bussel J.B. Intracranial hemorrhage in immune thrombocytopenic purpura: a retrospective analysis. J Pediatr Hematol Oncol 2003; 25 (8): 660–4.
17. Ree I.M.C., Fustolo-Gunnink S.F., Bekker V., Fijnvandraat K.J., Steggerda S.J., Lopriore E. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One 2017; 12 (10): e0185581.
18. Eltawel M., AlHarbi T., AlJamaan K., Alsaif S., Ali Y., Salam M. A Prospective Study on the Incidence and Outcomes of Neonatal Thrombocytopenia at a Tertiary Care Facility in Central Saudi Arabia. Adv Neonatal Care 2018; 18 (5): E3–12.
19. Arabdin M., Khan A., Zia S., Khan S., Khan G.S., Shahid M. Frequency and Severity of Thrombocytopenia in Neonatal Sepsis. Cureus 2022; 14 (2): e22665.
20. Brojer E., Husebekk A., Dębska M., Uhrynowska M., Guz K., Orzińska A., et al. Fetal/Neonatal Alloimmune Thrombocytopenia: Pathogenesis, Diagnostics and Prevention. Arch Immunol Ther Exp (Warsz) 2016; 64 (4): 279–90.
21. Carr R., Kelly A.M., Williamson L.M. Neonatal thrombocytopenia and platelet transfusion - a UK perspective. Neonatology 2015; 107 (1): 1–7.
22. Масчан А.А., Хачатрян Л.А., Сунцова Е.В., Новичкова Г.А. Дифференциальный диагноз и подходы к лечению тромбоцитопений у детей первого месяца жизни. Педиатрия. Журнал им. Г.Н. Сперанского 2019; 92 (2): 157–65.
23. Гуржиханова M.Х., Шестопалов Г.И., Васильева М.С., Петрова У.Н., Антонова К.С., Федорова Д.В. и др. MECOM-ассоциированный синдром: обзор литературы и собственные клинические наблюдения. Вопросы гематологии/онкологии и иммунопатологии в педиатрии 2022; 21 (3): 65–76. DOI: 10.24287/1726-1708-2022-21-3-65-76
Pediatric Hematology/Oncology and Immunopathology. 2024; 23: 34-46
Thrombocytopenia of newborns: an observational study
https://doi.org/10.24287/1726-1708-2024-23-4-34-46Abstract
Thrombocytopenia is a common abnormality in neonates. The etiology of neonatal thrombocytopenia ranges from common acquired causes such as immune-mediated thrombocytopenia and sepsis to rare congenital syndromes. There may be objective difficulties in identifying the causes of thrombocytopenia in newborns in the clinical practice. All hematological and nonhematological features of a newborn and his family members must be taken into account for an accurate diagnosis. In our study, we analysed a cohort of 52 children with thrombocytopenia developed in the neonatal period and retrospectively assessed the range of their possible clinical diagnoses. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology of Ministry of Healthcare of the Russian Federation. Perinatal infections and sepsis are often associated with thrombocytopenia. Immune thrombocytopenias are still “diagnoses of exclusion”. In 18 (34.6%) cases, molecular genetic testing confirmed rare congenital syndromes associated with thrombocytopenia. Despite various etiology, donor platelet transfusion with or without intravenous immunoglobulin remains the main treatment method of neonatal thrombocytopenia.
References
1. de Alacon P.A., Werner E. Neonatal Hematology. Cambridge University Press; 2005.
2. Donato H. Neonatal thrombocytopenia: A review. I. Definitions, differential diagnosis, causes, immune thrombocytopenia. Arch Argent Pediatr 2021; 119 (3): e202–14.
3. Donato H. Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion. Arch Argent Pediatr 2021; 119 (4): e303–14.
4. Sola-Visner M., Saxonhouse M.A., Brown R.E. Neonatal thrombocytopenia: what we do and don't know. Early Hum Dev 2008; 84 (8): 499– 506.
5. Chakravorty S., Roberts I. How I manage neonatal thrombocytopenia. Br J Haematol 2012; 156 (2): 155–62.
6. Roberts I., Murray N.A. Neonatal thrombocytopenia: causes and management. Arch Dis Child Fetal Neonatal Ed 2003; 88 (5): F359–64.
7. Gunnink S.F., Vlug R., Fijnvandraat K., van der Bom J.G., Stanworth S.J., Lopriore E. Neonatal thrombocytopenia: etiology, management and outcome. Expert Rev Hematol 2014; 7 (3): 387–95.
8. Rodeghiero F., Stasi R., Gernsheimer T., Michel M., Provan D., Arnold D.M., et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113 (11): 2386–93.
9. Patel R.M., Josephson C. Neonatal and pediatric platelet transfusions: current concepts and controversies. Curr Opin Hematol 2019; 26 (6): 466–72.
10. Peng T., Shan Y., Zhang P., Cheng G. Bleeding in neonates with severe thrombocytopenia: a retrospective cohort study. BMC Pediatr 2022; 22 (1): 730.
11. Resch E., Hinkas O., Urlesberger B., Resch B. Neonatal thrombocytopenia-causes and outcomes following platelet transfusions. Eur J Pediatr 2018; 177 (7): 1045–52.
12. Saber A.M., Aziz S.P., Almasry A.Z.E., Mahmoud R.A. Risk factors for severity of thrombocytopenia in full term infants: a single center study. Ital J Pediatr 2021; 47 (1): 7.
13. Peterson J.A., McFarland J.G., Curtis B.R., Aster R.H. Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management. Br J Haematol 2013; 161 (1): 3–14.
14. Pecci A., Balduini C.L. Inherited thrombocytopenias: an updated guide for clinicians. Blood Rev 2021; 48: 100784.
15. Stanworth S.J., Mumford A.D. How I diagnose and treat neonatal thrombocytopenia. Blood 2023; 141 (22): 2685–97.
16. Butros L.J., Bussel J.B. Intracranial hemorrhage in immune thrombocytopenic purpura: a retrospective analysis. J Pediatr Hematol Oncol 2003; 25 (8): 660–4.
17. Ree I.M.C., Fustolo-Gunnink S.F., Bekker V., Fijnvandraat K.J., Steggerda S.J., Lopriore E. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One 2017; 12 (10): e0185581.
18. Eltawel M., AlHarbi T., AlJamaan K., Alsaif S., Ali Y., Salam M. A Prospective Study on the Incidence and Outcomes of Neonatal Thrombocytopenia at a Tertiary Care Facility in Central Saudi Arabia. Adv Neonatal Care 2018; 18 (5): E3–12.
19. Arabdin M., Khan A., Zia S., Khan S., Khan G.S., Shahid M. Frequency and Severity of Thrombocytopenia in Neonatal Sepsis. Cureus 2022; 14 (2): e22665.
20. Brojer E., Husebekk A., Dębska M., Uhrynowska M., Guz K., Orzińska A., et al. Fetal/Neonatal Alloimmune Thrombocytopenia: Pathogenesis, Diagnostics and Prevention. Arch Immunol Ther Exp (Warsz) 2016; 64 (4): 279–90.
21. Carr R., Kelly A.M., Williamson L.M. Neonatal thrombocytopenia and platelet transfusion - a UK perspective. Neonatology 2015; 107 (1): 1–7.
22. Maschan A.A., Khachatryan L.A., Suntsova E.V., Novichkova G.A. Differentsial'nyi diagnoz i podkhody k lecheniyu trombotsitopenii u detei pervogo mesyatsa zhizni. Pediatriya. Zhurnal im. G.N. Speranskogo 2019; 92 (2): 157–65.
23. Gurzhikhanova M.Kh., Shestopalov G.I., Vasil'eva M.S., Petrova U.N., Antonova K.S., Fedorova D.V. i dr. MECOM-assotsiirovannyi sindrom: obzor literatury i sobstvennye klinicheskie nablyudeniya. Voprosy gematologii/onkologii i immunopatologii v pediatrii 2022; 21 (3): 65–76. DOI: 10.24287/1726-1708-2022-21-3-65-76
