Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Radiology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea.
BMC Pediatr. 2021 Jan 23;21(1):49. doi: 10.1186/s12887-021-02510-9.
Peripheral blood eosinophilia is identified in numerous medical conditions associated with allergic, infectious, and inflammatory processes mostly as reactive eosinophilia with or without tissue eosinophilia. In hospitalized neonates, eosinophilia is common with an inverse relationship with gestational age and occurs solely as mild eosinophilia in the majority of cases. In the literature, eosinophilia has been proposed as a possible risk factor for venous thromboembolism. However, few reports are found on thromboembolic events including portal vein thrombosis (PVT) associated with eosinophilia in the newborn period. Neonates, particularly preterm infants, are vulnerable to thrombosis due to the immature and developing hemostatic system with little reserve capacity, which occurs as catheter-related thrombosis in most cases.
A male newborn at 34 weeks' gestation presented with a left portal venous thrombus and hematochezia after initial cow's milk feeding in the setting of blood hypereosinophilia for a prolonged period of time without central venous catheterization. The infant was diagnosed with PVT and food protein-induced allergic proctocolitis (FPIAP) and showed complete resolution of the conditions with expectant management with food avoidance, including the normalized eosinophil count.
Our experience suggests that in the setting of hypereosinophilia with a prolonged duration in premature neonates, FPIAP should be suspected in case of hematochezia in otherwise healthy infants, and considering the increased thrombotic risk by the hypereosinophilia and premature newborn status, evaluation for neonatal thrombosis may be needed, including PVT with the potential risk for the more serious, but uncommon, late complications encompassing portal hypertension.
外周血嗜酸性粒细胞增多可见于多种与过敏、感染和炎症过程相关的医学病症，主要表现为反应性嗜酸性粒细胞增多，伴有或不伴有组织嗜酸性粒细胞增多。在住院新生儿中，嗜酸性粒细胞增多很常见，与胎龄呈负相关，且大多数情况下仅表现为轻度嗜酸性粒细胞增多。在文献中，嗜酸性粒细胞增多被认为是静脉血栓栓塞的一个可能危险因素。然而，关于新生儿期嗜酸性粒细胞增多与血栓栓塞事件（包括门静脉血栓形成[PVT]）相关的报道很少。新生儿，特别是早产儿，由于不成熟和正在发育的止血系统储备能力有限，容易发生血栓形成，大多数情况下是导管相关的血栓形成。
一名 34 周龄的男性新生儿，在最初接受牛奶喂养后出现左门静脉血栓形成和血便，在此之前，他的血液嗜酸性粒细胞持续长时间增多，但没有接受中心静脉置管。该婴儿被诊断为 PVT 和食物蛋白诱导的过敏直肠结肠炎（FPIAP），通过避免食用相关食物（包括嗜酸性粒细胞计数恢复正常）进行期待治疗，病情完全缓解。
我们的经验表明，在早产儿嗜酸性粒细胞持续时间较长的情况下，如果其他方面健康的婴儿出现血便，应怀疑 FPIAP，并且由于嗜酸性粒细胞增多和早产儿状态增加了血栓形成的风险，可能需要对新生儿进行血栓形成评估，包括 PVT，其潜在风险包括更严重但罕见的晚期并发症，包括门静脉高压。
