Patterns of Neonatal Thrombocytopenia with A Note on Platelet Indices and Optical Technology – A Cross-Sectional Study

Abstract

Introduction: Neonatal thrombocytopenia is defined as a platelet count <150×10^9/L regardless of gestational-age. It results from hypo-proliferation in marrow or peripheral destruction of platelets. Platelet count can be rapidly measured using automated hematology analyzers, but peripheral smear remains best method. The causes of neonatal thrombocytopenia are defined by time of presentation into foetal (mainly TORCH infections), early  (< 3 days), and late. The present study highlights pattern and severity of neonatal thrombocytopenia in study hospital, adding importance of platelet indices and optical technology. Aim: To study patterns and severity of neonatal thrombocytopenia, platelet indices and to measure accuracy of platelet count by optical technology methods against peripheral smear. Materials and methods: A cross-sectional study done for a period of 8 months from December 2018 to July 2019, at ASRAM medical college, Eluru. During this period blood samples of 113 critical cases of newborns, admitted with thrombocytopenia, were collected in Ethylenediamine tetra acetic acid (EDTA) vials. The platelet count was analyzed by two automated analyzers, Sysmex XN1000 and Horiba ABX Pentra XL 80. The Leishman-stained films were examined under a light microscope. ANOVA test was used to find mean difference between platelet counts, sensitivity, and specificity, and accuracy was calculated by MEDCALC CALCULATOR. Results: Out of total of 113 critical cases of new-borns admitted to Neonatal intensive care unit (NICU) at institute, 85 presented with thrombocytopenia. The variation of platelet indices was noted in 40 cases, blood cultures were collected in 77 cases.  Thrombocytopenia showing platelet count less than 20,000/ mm3 is considered very severe, with 30.5% (26 cases) of total number. Elevated platelet indices were noted at 47.5%. The common clinical diagnosis was neonatal sepsis (42.3%), followed by neonatal jaundice (18.8%).  The light scatterer principle of platelet evaluation proved to have better accuracy than electrical impedance, in comparison to peripheral smear findings. Conclusion: The study concludes that neonatal septicemia is major cause of neonatal thrombocytopenia as proved by correlating platelet count with platelet indices.  And also, usage of automated hemogram reports with platelet indices, is a source of information to suspect etiology of thrombocytopenia thereby preventing adverse outcomes. The principle of Optical Light scatterer technique in an automated analyzer gives better results than the electrical impedance technique for detecting platelet count value, though peripheral smear examination is mandatory for confirmation.