Kamsetti Saritha, Tammali Saritha, Urakurva Ashok Kumar, Kotha Rakesh
Pediatrics, Government Medical College, Vikarabad, Vikarabad, IND.
Pediatrics, Niloufer Hospital, Hyderabad, IND.
Cureus. 2024 Jul 31;16(7):e65818. doi: 10.7759/cureus.65818. eCollection 2024 Jul.
In newborns, especially premature babies, there is a high association between thrombocytopenia and bleeding, particularly intraventricular hemorrhage, which may be due to immaturity. It was usual clinical practice that neonates should be transfused with higher platelet counts than older children or adults to reduce their risk of bleeding. However, after keen observations, we noticed that bleeding and mortality were more common in newborns who received more platelet transfusions. The mechanisms underlying the adverse effects of platelet transfusions in neonates may be due to higher antigenicity and immunological factors. We know that neonatal platelets are hyporeactive; this hyporeactivity is balanced by factors in the neonatal blood that promote coagulation, such as increased hematocrit, von Willebrand factor, and fibrinogen, which, on balance, leads to normal primary neonatal hemostasis. Platelets are very similar to adults in number, but functional capabilities were less, and for the reasons mentioned above, particularly bleeding time was short. Theologically, neonatal platelet lifespan was high to compensate for less production. We started this review because we observed that many babies were not having bleeding symptoms in some instances of severe thrombocytopenia. Many well-active babies are receiving unnecessary transfusions, as human blood is precious, and many young neonatologists are going on protocol-based excessive transfusions. This stimulated us to write a review.
在新生儿中，尤其是早产儿，血小板减少与出血之间存在高度关联，特别是脑室内出血，这可能是由于不成熟所致。通常的临床做法是，与大龄儿童或成人相比，新生儿应输注更高血小板计数的血液以降低出血风险。然而，经过仔细观察，我们注意到接受更多血小板输注的新生儿出血和死亡更为常见。新生儿血小板输注产生不良反应的潜在机制可能是由于更高的抗原性和免疫因素。我们知道新生儿血小板反应性低下；这种低反应性由新生儿血液中促进凝血的因素平衡，如血细胞比容增加、血管性血友病因子和纤维蛋白原，总体上导致新生儿原发性止血正常。新生儿血小板数量与成人非常相似，但功能能力较低，并且由于上述原因，特别是出血时间较短。从理论上讲，新生儿血小板寿命较长以弥补产量较低的情况。我们开展这项综述是因为我们观察到在一些严重血小板减少的情况下，许多婴儿没有出血症状。许多状况良好的婴儿正在接受不必要的输血，因为人类血液很珍贵，而且许多年轻的新生儿科医生正在按照方案进行过度输血。这促使我们撰写一篇综述。
