NEONATAL PLATELET TRANSFUSIONS

Thrombocytopenia occurs in 20% to 40% of infants admitted to a neonata l intensive care unit. Approximately 30% of the newborns with severe t hrombocytopenia below 50.10(9)/1 platelets receive platelet transfusio ns. The etiology may be : bacterial infection, DIC and immune mediated thrombocytopenia. The consequences of thrombocytopenia are significia nt risks of severe intracranial hemorrhage and neurologic morbidity. T herapeutic platelet transfusions are given to actively bleeding neonat es with less than 50.10(9)/1 platelets. Prophylactic platelet concentr ates are usually given to infants with platelets counts below 20.10(9) /1. The standard platelet concentrate (CMV-negative donor) is the prod uct of choice for newborns. Fetal intracranial hemorrhage is possible as soon as 20 weeks of gestation in allo-immune thrombocytopenia. Actu ally percutaneous umbilical blood sampling is very usefull to measure fetal platelets count in order to decide in utero maternal platelet tr ansfusion. Maternal irradiated plateletpheresis concentrates are prefe rentially infused in this indication. At the end of pregnancy, cesarea n section is preferred to normal vaginal delivery if fetal thrombocyto penia below 100.10(9)/1 is observed. In pregnant women with auto-immun e thrombocytopenia, the decision to carry out percutaneous umbilical b lood samples should be weigh relatively to the 3 - 5% estimated risk o f serious consequences. Platelets transfusions are particularly succes sfull in immune thrombocytopenia but less effective in other clinical circumstances.