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Thrombocytosis in neonates and young infants: a report of 25 patients with platelet counts of ⩾1 000 000 μl−1

Journal of Perinatology volume 30, pages 222–226 (2010)Cite this article

Abstract

Objective:

Thrombocytosis has been reported in neonates and young infants, but little is known of its prevalence, timing of onset, associated conditions, sequelae and outcomes. To better understand this condition, we used the data repositories of a multi-hospital health-care system to identify all individuals ⩽140 days old (20 weeks) who, during the past 6 years, had a platelet count of ⩾1 000 000 μl−1.

Study Design:

We identified all infants with extreme thrombocytosis (using the Sutor definition of a platelet count of ⩾1 000 000 μl−1) during the period of January 2003 through December 2008 in any Intermountain Healthcare facility. We obtained the information provided in this report from electronic and paper records.

Result:

Among 40 471 infants who had one or more platelet counts performed in this period, 25 had extreme thrombocytosis. No cases were identified in the first week after birth, 40% were recognized between the second and fourth weeks and 40% between the fifth and eighth week. The prevalence of thrombocytosis had no relationship with birth weight or gestational age but a slight predominance of female patients (15/25) was noted. In all, 26 episodes were found among the 25 infants: 12 episodes involved an antecedent infectious disease, 8 had an antecedent surgical procedure, 4 had the anemia of prematurity and 1 each had congenital adrenal hyperplasia and opiate withdrawal syndrome. No pathological thromboses or hemorrhages or other sequelae were detected and all episodes resolved with no deaths.

Conclusion:

The thrombocytosis cases that we report were all consistent with reactive thrombocytosis (also known as secondary thrombocytosis); none seemed to be essential (primary) thrombocytosis. We speculate that the pathogenesis involves increased platelet production due to megakaryopoietic stimulators induced by an infectious or inflammatory condition. From this series and previous reports, young infants with platelet counts up to 1 300 000 μl−1 do not seem to have a significant risk of thrombotic or hemorrhagic problems, and do not generally require anti-platelet or cytoreductive treatment.

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References

  1. Vardiman JW, Brunning RD, Harris NL . WHO histological classification of chronic myeloproliferative diseases. In: Jaffe ES, Harris NL, Stein H, Vardiman JW (eds) World Health Organization Classification of Tumors: Tumors of the Haematopoietic and Lymphoid Tissues. International Agency for Research on Cancer (IARC) Press: France, 2001 pp 17–44.

    Google Scholar 

  2. Chan KW, Kaikov Y, Wadsworth LD . Thrombocytosis in childhood: A survey of 94 patients. Pediatrics 1989; 84 (6): 1064–1067.

    CAS  PubMed  Google Scholar 

  3. Vora AJ, Lilleyman JS . Secondary thrombocytosis. Arch Dis Child 1993; 68: 88–90.

    Article  CAS  Google Scholar 

  4. Yohannan MD, Higgy KE, Al-Mashhadani SA, Santhosh-Kumar CR . Thrombocytosis: etiologic analysis of 663 patients. Clin Pediatr (Phil) 1994; 33 (6): 340–343.

    Article  CAS  Google Scholar 

  5. Sutor AH . Thrombocytosis in childhood. Semin Thromb Hemost 1995; 21: 330–339.

    Article  CAS  Google Scholar 

  6. Sutor AH . Thrombocytosis. In: Lilleyman JS, Hann IM, Blanchette VS (eds) Pediatric Hematology. Harcourt Publishers Ltd: New York, 1999 pp 455–464.

    Google Scholar 

  7. Matsubara K, Fukaya T, Nigami H, Harigaya H, Hirata T, Nozaki H et al. Age-dependent changes in the incidence and etiology of childhood thrombocytosis. Acta Haematol 2004; 111: 132–137.

    Article  Google Scholar 

  8. Wiedmeier SE, Henry E, Sola-Visner MC, Christensen RD . Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. J Perinatol 2008; 29 (2): 130–136.

    Article  Google Scholar 

  9. Buss DH, Cashell AW, O’Connor ML, Richards 2nd F, Case LD . Occurrence, etiology, and clinical significance of extreme thrombocytosis: a study of 280 cases. Am J Med 1994; 96 (3): 247–253.

    Article  CAS  Google Scholar 

  10. Schmuziger M, Christenson JT, Maurice J, Simonet R, Velebit V . Reactive thromobocytosis after coronary bypass surgery. An important risk factor. Eur J Cardiothorac Surg 1995; 9 (7): 393–397.

    Article  CAS  Google Scholar 

  11. Rinder HM, Schuster JE, Rinder CS, Wang C, Schweidler HJ, Smith BR . Correlation of thrombosis with increased platelet turnover in thrombocytosis. Blood 1998; 91 (4): 1288–1294.

    CAS  PubMed  Google Scholar 

  12. Keung Y-K, Owen J . Iron deficiency and thrombosis: literature review. Clin Appl Thromb Hemost 2004; 10 (4): 387–391.

    Article  CAS  Google Scholar 

  13. Mesa RA, Silverstein MN, Jacobsen SJ . Population based incidence and survival figures in essential thrombocythemia and agnogenic myeloid metaplasia, Olmsted County Study, 1976–1995. Am J Hematol 1999; 61 (1): 10–15.

    Article  CAS  Google Scholar 

  14. Phekoo KJ, Richard MA, Moller H, Schey SA . South Thames Haematology Specialist Committee. The incidence and outcome of myeloid malignancies in 2112 adult patients in southeast England. Haematologica 2006; 91: 1400–1404.

    PubMed  Google Scholar 

  15. Johansson P, Kutti J, Andreasson B, Safai-Kutti S, Vilen L, Wedel H et al. Trends in the incidence of chronic Philadelphia chromosome negative (Ph-) myeloproliferative disorders in the city of Goteborg, Sweden, during 1983–99. J Intern Med 2004; 256 (2): 161–165.

    Article  CAS  Google Scholar 

  16. Jensen MK, de Nully Brown P, Nielsen OJ, Hasselbalch HC . Incidence, clinical features and outcome of essential thrombocythaemia in a well defined geographical area. Eur J Haematol 2000; 65: 132–139.

    Article  CAS  Google Scholar 

  17. Schafer AI . Thrombocystosis. N Engl J Med 2004; 350: 1211–1219.

    Article  CAS  Google Scholar 

  18. Dror Y, Zipursky A, Blanchette VS . Essential thrombocythemia in children. J Pediatr Hematol Oncol 1999; 21: 356–363.

    Article  CAS  Google Scholar 

  19. Hasle H . Incidence of essential thrombocythaemia in children. Br J Haematol 2000; 110: 751.

    Article  CAS  Google Scholar 

  20. Dame C, Sutor AH . Primary and secondary thrombocytosis in childhood. Br J Haematol 2005; 129: 165–177.

    Article  CAS  Google Scholar 

  21. Dame C . Thrombocytosis. In: Arceci RJ, Hann IM, Smith OP (eds) Pediatric Hematology. Blackwell Publishing: Massachusetts, 2006 pp 548–561.

    Chapter  Google Scholar 

  22. Schilling RF . Platelet millionaires. Lancet 1980; 2: 372–373.

    Article  CAS  Google Scholar 

  23. Denton A, Davis P . Extreme thrombocytosis in admissions to paediatric intensive care: no requirement for treatment. Arch Dis Child 2007; 92: 515–516.

    Article  Google Scholar 

  24. Kaushansky K . Thrombopoietin. N Engl J Med 1998; 339: 746–754.

    Article  CAS  Google Scholar 

  25. Begley CG, Basser RL . Biologic and structural differences of thrombopoietic growth factors. Semin Hematol 2000; 37: 19–27.

    Article  CAS  Google Scholar 

  26. Ishiguro A, Suzuki Y, Mito M, Shimbo T, Matsubara K, Kato T et al. Elevations of serum thrombopoietin precedes thrombocytosis in acute infections. Br J Haematol 2002; 116: 612–618.

    Article  CAS  Google Scholar 

  27. O’Shea J, Sherlock M, Philip R . Thrombocytosis in childhood. Acta Haematol 2005; 113: 212.

    Article  Google Scholar 

  28. Robbins G, Barnard DL . Thrombocytosis and microthrombocytosis: a clinical evaluation of 372 cases. Acta Haematologica 1983; 70: 175–182.

    Article  CAS  Google Scholar 

  29. Folman CC, Ooms M, Kuenen BB, de Jong SM, Vet RJ, de Haas M et al. The role of thrombopoietin in post-operative thrombocytosis. Br J Haematol 2001; 114: 126–133.

    Article  CAS  Google Scholar 

  30. Schloesser LL, Kipp MA, Wenzel FJ . Thrombocytosis in iron-deficiency anemia. J Lab Clin Med 1965; 66: 107–114.

    Google Scholar 

  31. Gross S, Keefer V, Newman AJ . The platelets in iron-deficiency anemia. I. The response to oral and parenteral iron. Pediatrics 1964; 34: 315–323.

    CAS  PubMed  Google Scholar 

  32. Donato H, Vain N, Rendo P, Vivas N, Prudent L, Larguia M et al. Effect of early versus late administration of human recombinant erythropoietin on transfusion requirements in premature infants: result of a randomized, placebo-controlled, multicenter trial. Pediatrics 2000; 105: 1066–1072.

    Article  CAS  Google Scholar 

  33. Gasparini N, Franzese A, Argenziano A, Di Maio S, Tenore A . Thrombocytosis in congenital adrenal hyperplasia at diagnosis. Clin Pediatr 1996; 35: 267–269.

    Article  CAS  Google Scholar 

  34. Burstein Y, Giardina PJV, Rausen AR, Kandall SR, Siljestrom K, Peterson CM . Thrombocytosis and increased circulating platelet aggregates in newborn infants of polydrug users. J Pediatr 1979; 94: 895–899.

    Article  CAS  Google Scholar 

  35. Burstein Y, Rausen AR, Peterson CM . Duration of thrombocytosis in infants of polydrug (including methadone) users. J Pediatr 1982; 100: 506.

    Article  CAS  Google Scholar 

  36. Chambers HM, Haslam RR . Maternal narcotic abuse and neonatal thrombocytosis. Arch Dis Child 1989; 64: 426.

    Article  CAS  Google Scholar 

  37. Garcia-Algar O, Brichs LF, Garcia ES, Fabrega DM, Torne EE, Sierra AM . Methadone and neonatal thrombocytosis. Pediatr Hematol Oncol. 2002; 19: 193–195.

    Article  Google Scholar 

  38. Burstein Y, Grady RW, Kreek MJ, Kreek MJ, Rausen AR, Peterson CM . Thrombocytosis in the offspring of female mice receiving DL-methadone (40861). Proc Soc Exp Biol Med 1980; 164: 275–279.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, UT, USA

    S E Wiedmeier, E Henry, J Burnett, T Anderson & R D Christensen

  2. Division of Neonatology, Intermountain Medical Center, Murray, UT, USA

    S E Wiedmeier, J Burnett & T Anderson

  3. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    S E Wiedmeier

  4. Institute for Healthcare Delivery Research, Salt Lake City, UT, USA

    E Henry

  5. Division of Neonatology, McKay-Dee Hospital Center, Ogden, UT, USA

    R D Christensen

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  1. S E Wiedmeier
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Correspondence to S E Wiedmeier.

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Wiedmeier, S., Henry, E., Burnett, J. et al. Thrombocytosis in neonates and young infants: a report of 25 patients with platelet counts of ⩾1 000 000 μl−1. J Perinatol 30, 222–226 (2010). https://doi.org/10.1038/jp.2009.146

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