Title:Pitfalls and Limitations of Platelet Counts and Coagulation Tests in the
Neonatal Intensive Care Unit
Volume: 19
Issue: 4
Author(s): Patricia Davenport*Martha Sola-Visner*
Affiliation:
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
Keywords:
Neonatal hematology, hemostasis, neonatologists, infants, bleeding, platelet count.
Abstract: The assessment of hemostasis and the prediction of bleeding risk are of great importance
to neonatologists. Premature infants are at an increased risk for bleeding, particularly intra-cranial
hemorrhages (most commonly intra-ventricular hemorrhages (IVH)), gastrointestinal hemorrhages,
and pulmonary hemorrhages. All severe bleeding, but especially severe IVH, is associated with
poor neurodevelopmental outcomes, and other than prenatal steroids, no intervention has reduced
the incidence of this serious complication. As a result, there is a need in neonatology to more accurately
identify at-risk infants as well as effective interventions to prevent severe bleeding. Unfortunately,
the commonly available tests to evaluate the hemostatic system were established using adult
physiologic principles and did not consider the neonate's different but developmentally appropriate
hemostatic system. This review will describe the changes in the platelet count and tests of hemostasis
throughout development, the limitations of these tests to predict neonatal bleeding and the utility
of treating abnormal results from these tests with platelet and/or fresh frozen plasma (FFP) transfusions
in non-bleeding infants.
