Severe thrombocytopenia and patterns of bleeding in neonates: Results from a prospective observational study and implications for use of platelet transfusions

Objective: To describe patterns of clinical bleeding in neonates with severe thrombocytopenia (ST and platelet count <60 × 10⁹ L^-1), and to investigate the factors related to bleeding. Study design: Seven tertiary-level neonatal units enrolled neonates (n=169) with ST. Data were collected prospectively on all clinically apparent haemorrhages. Relationships between bleeding, platelet count and baseline characteristics were explored through regression analysis. Results: Bleeding was recorded in most neonates with ST (138/169; 82%), including 123 neonates with minor bleeding and 15 neonates with major bleeding. The most common sites of minor bleeding were from the renal tract (haematuria 40%), endotracheal tube (21%), nasogastric tube (10%) and skin (15%). Gestational age <34weeks, development of ST within 10days of birth and necrotizing enterocolitis were the strongest predictors for an increased number of bleeding events. For neonates with ST, a lower platelet count was not a strong predictor of increased bleeding. Conclusions: The majority of neonates with ST bleed, although most episodes are minor. These findings establish the importance of clinical factors for bleeding risk, rather than minimum platelet count. Further studies should assess the clinical significance of different types of minor bleed for neonatal outcomes, the predictive value of minor bleeding for major bleeding and the role of platelet transfusions in preventing bleeding. Transfusion Medicine