Background and aim Thrombocytopenia has been linked to an increased risk of major intraventricular-periventricular haemorrhage (IVH-PVH) in preterm neonates. Recent studies observing neonatal thrombocytopenia found no causative relationship between severe thrombocytopenia and major haemorrhage, but confirmation whether IVH-PVH is a cause or effect of thrombocytopenia is lacking. We aimed to determine the temporal relationship between the timing of major bleeding and significant thrombocytopenia (platelet count <100 x109/L) in neonates with major IVH-PVH.
Methods Retrospective review of all neonates admitted to our neonatal unit between 01/01/2005 and 31/12/2010 who had major IVH-PVH. We analysed case notes, haematology results, and cranial ultrasonograms to determine, where possible, the timing of each infant's IVH-PVH based on acute clinical symptoms, significant fall in haemoglobin concentration, and appearances on ultrasonograms. We recorded platelet counts from up to 3 days before and 7 days after the major IVH-PVH.
Results Complete data were available for 48/64 (75%) neonates in the 6-year study period. 22/48 (46%) neonates already had major IVH-PVH evident on their very first ultrasonogram and therefore had no definite pre-bleed platelet count available. 26/48 (54%) neonates with an initial normal ultrasonogram had major IVH-PVH on subsequent ultrasonography, with the haemorrhage occurring at a median postnatal age of 27 hours. Of these, only 3/26 (12%) were already significantly thrombocytopenic before their IVH-PVH (pre-bleed platelet count range: 53-75×109/L), 21/26 (81%) became significantly thrombocytopenic post the IVH-PVH (with median nadir post-bleed platelet count 40 x109/L [range: 7-99×109/L]), and only 2/26 (8%) maintained a platelet count of >100 x109/L in the wake of the major IVH-PVH. Of 22 infants with definite pre- and post-bleed platelet counts available, the median fell from 146 x109/L pre-bleed (range 40-318×109/L), to a nadir of median 46 x109/L post-bleed (range 7-252×109/L).
Conclusion Most preterm neonates who develop major IVH-PVH become significantly thrombocytopenic as a direct consequence of the bleeding event. These data imply that prophylactically transfusing platelets to thrombocytopenic neonates in an attempt to prevent major intraventricular haemorrhage is belated.