scholarly journals A study of bacterial sepsis and its relation to thrombocytopenia in neonates

2017 ◽  
Vol 4 (3) ◽  
pp. 1032
Author(s):  
Vikram R. Goudar ◽  
Gautam Mohan Kabbin ◽  
Suhas N. Joshi ◽  
Vinod P. Chavan ◽  
Shriharsha L. Badiger
Keyword(s):  
Platelet Count ◽  
Bacterial Growth ◽  
White Blood Cells ◽  
P Value ◽  
Suspected Case ◽  
Severe Thrombocytopenia ◽  
Bacterial Sepsis ◽  
Klebsiella Species ◽  
Culture Positivity ◽  
District Hospitals

Background: In developing countries like India, the culture facilities are non-existent in most of the district hospitals, so the burden of identification of sepsis lies on hematological investigations like platelet count and white blood cells and very few indian studies have been done to show the association. Objectives: 1) To know the incidence of thrombocytopenia in babies with proven bacterial sepsis. 2) To find, if any, species specific differences in severity and incidence of thrombocytopenia. 3) Clinical outcomes in thrombocytopenic and nonthrombocytopenic septic babies.Methods: It is a prospective observational hospital based study. All the neonates admitted to our NICU with probable sepsis were screened for sepsis and neonates with birth weight of 1000 grams and above with blood and/or Cerebrospinal Fluid (CSF) culture positivity for bacterial growth were recruited during the study period from November 2011 to October 2012. A total of 100 neonates with blood and/or CSF culture positivity for bacterial growth were considered convenient for the study.Results: During the present study period of 1 year we had a total of 960 Neonates admitted to our NICU. 475 neonates were screened for sepsis.  A total of 100 neonates with blood and/or CSF culture positivity for bacterial growth were considered for the study. Klebsiella pneumoniae sepsis was the highest contributor to the severe thrombocytopenia category (15 out of 29cases). Out of the 100 cases, 41 had normal platelet count and 59 had thrombocytopenia. Klebsiella positivity was more significantly associated with severe thrombocytopenia than MRCONS positivity or rest of the cultures combined together (p value <0.01). Although there was no significant association between thrombocytopenia and mortality (p=0.176), the proportion of children with severe thrombocytopenia was significantly higher in babies who expired (25% vs 9%) when compared to babies who survived.Conclusions: Our study shows that in our setting bacterial sepsis is significantly complicated by thrombocytopenia. Severe thrombocytopenia in a suspected case of bacterial sepsis might predict Klebsiella species sepsis and hence it may be prudent to start empirical antibiotics covering the Klebsiella species. 

Immature Platelet Fraction in Patients with Chronic Liver Disease, A Marker for Evaluating Cirrhotic Changes.

2021 ◽  
Vol 17 (2) ◽  
pp. 174-179
Author(s):  
Muhammad Javaid Iqbal ◽  
Muhammad Usman ◽  
Mubarak Ali Anjum ◽  
Yasir Yaqoob ◽  
Ghulam Mujtaba Nasir ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
White Blood Cells ◽  
Chronic Liver ◽  
Control Group ◽  
P Value ◽  
Master Program ◽  
Immature Platelet Fraction ◽  
The Mean

Objective: To evaluate the role of Immature platelet fraction in patients with chronic liver disease, a marker for evaluating cirrhotic changes. Methodology: This case control study was conducted at department of Pathology, Aziz Fatima Medical and Dental College, Faisalabad, over a period of Seven months from June 2020 to January 2021. A total of 126 participants were included in the study consisting of 63 patients with chronic liver disease in group A and 63 participants without any known disease in group B as control. The IPF master program in combination with XE-2100 multiparameter automatic hematology analyzer was used to measure the immature platelet fraction. Ethylene diamine tetraacetic acid was used to collect the blood sample for IPF measurement and was maintained till analysis on room temperature. Ten repeated analyses, immediately and after 24 hours were done for reproducibility of IPF%. Results: The mean age of liver disease patients was 52.35 ± 13.64 years and in control group the mean age was 51.62 ± 11.27 years. There was no significant (p-value > 0.05) difference between both groups based on age and gender. The hemoglobin level and red cell count was found to be significantly (p-value < 0.05) reduced in cases group. While white blood cells count was comparable in both groups. The mean platelet count was significantly (p-value < 0.05) less in cases group (163.5 ± 90.4 vs 233.4 ± 54.5 (x10*3/µl). The mean value of immature platelet fraction (IPF%) was significantly (p-value < 0.05) raised in cases group (5.62 ± 2.92 vs 3.06 ± 1.87). The multivariate discriminant analysis (MDA) score showed a significant (p-value < 0.05) association with chronic hepatis as compared to other liver related diseases. Conclusions: In chronic liver disease patients, there is an inverse relationship between platelet count and IPF% with decreased platelet count and increased IPF%. The proposed MDA function can be used to identify the cirrhotic changes in liver disease patients.

scholarly journals Prevalence of thrombocytopenia in neonates admitted in NICU with culture proven sepsis

2018 ◽  
Vol 5 (3) ◽  
pp. 743 ◽  
Author(s):  
Shivraj Singh ◽  
Avyact Agrawal ◽  
Uthara Mohan ◽  
Sukarn Awasthi
Keyword(s):  
Disease Process ◽  
Underlying Disease ◽  
Cross Sectional Study ◽  
Suspected Case ◽  
Severe Thrombocytopenia ◽  
Bacterial Sepsis ◽  
Cross Sectional ◽  
E Coli ◽  
Empirical Antibiotics ◽  
Culture Positive

Background: Thrombocytopenia is a common haematological problem encountered during neonatal period, particularly in the sick, premature neonates admitted in the NICU, and usually indicate an underlying disease process. Thrombocytopenia may be considered as an important and early tool in diagnosis of septicaemia in neonates.Methods: It is a hospital based cross sectional study. A total 105 neonates with blood and/CSF culture positive sepsis and associated thrombocytopenia admitted in NICU. This study was conducted to find the prevalence of thrombocytopenia in neonates admitted in NICU with culture proven sepsis and to observe the outcome of thrombocytopenia and sepsis.Results: Out of 105 culture positive neonates K. pneumoniae 47/105 (44.8%) was the commonest micro-organism isolated, followed by Pseudomonas 26/105 (24.8%), E. coli 14/105 (13.3%), Staphylococcus 11/105 (10.5%), Candida 2/105 (1.9%) in decreasing order. Thrombocytopenia was present in 100/105 (95.2%). Among thrombocytopenic neonates 38/100 (38%), 36/100 (36%) and 26/100 (26%) having severe, moderate and mild thrombocytopenia respectively. 38 (38%) newborns of severe thrombocytopenia among them K. pneumoniae (50.0%) was commonest organism, followed by Pseudomonas. (23.7%) and Staphylococcus (15.8%) in the decreasing order. 36 (36%) newborns of moderate thrombocytopenia among them K. pneumoniae (47.2%) again commonest organism associated, followed by Pseudomonas. (25.0%), and E- coli (11.1%). In severe thrombocytopenic newborns both GI and pulmonary (60.50%) haemorrhage was the most common bleeding manifestation. Mortality rate (37.1%) was high in newborns having sepsis.Conclusions: Bacterial sepsis is significantly complicated by thrombocytopenia. Severe thrombocytopenia in a suspected case of bacterial sepsis might predict Klebsiella sepsis and hence it may be rational to start empirical antibiotics covering the same.

scholarly journals A study on effect of phototherapy on platelet count in neonates with unconjugated hyperbilirubinemia: a hospital based prospective observational study

2021 ◽  
Vol 12 (5) ◽  
pp. 41-46
Author(s):  
Santi Kumar Sarkar ◽  
Biswajit Biswas ◽  
Sumanta Laha ◽  
Nirban Sarkar ◽  
Monojit Mondal ◽  
...  
Keyword(s):  
Platelet Count ◽  
Observational Study ◽  
Gestational Age ◽  
Serum Bilirubin ◽  
Statistical Tests ◽  
Positive Association ◽  
Total Serum ◽  
P Value ◽  
Severe Thrombocytopenia ◽  
Unconjugated Hyperbilirubinemia

Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in standard literature and textbooks. Though there are few studies in this regard, but results are conflicting. Aims and Objective: Hence, the present study is undertaken to find out whether any significant change in platelet count occurs following phototherapy, and if there be any, to see whether the changes are transient or not. Materials and Methods: This prospective and observational study was carried out over a period of one and half years (1st March 2019 to 31st August 2020) on 190 new-borns admitted with idiopathic unconjugated hyperbilirubinemia needing phototherapy through consecutive enrolment. Serum bilirubin (total, conjugated and unconjugated) and platelet count were done before initiation and just after completion of phototherapy, and seven days after completion of phototherapy. Appropriate statistical tests were used to make statistical comparisons with a p-value of < 0.05 taken as significant. Results: Among 190 neonates, 108(56.8%) were male and 82(43.2%) were female; 90(47.4%) were preterm and 100(52.6%) were term. Mean birth weight was (2.4725 ± 0.4782) kg. Mean gestational age was (36.4316 ± 2.4802) weeks. Mean haemoglobin level was (17.3816± 1.0784) gm/dl. Mean age at presentation was (4.5737± 1.5811) days. Mean total serum bilirubin (TSB) before initiation, after completion, and 7 days after completion of phototherapy were (17.8595 ± 3.7034) mg/dl, (8.1726 ± 2.2586) mg/dl and (5.7279± 1.5918) mg/dl respectively. The mean duration of phototherapy required was (48.1895 ± 13.6054) hours. Mean platelet count before initiation and just after completion of phototherapy were (2,49,321.0526± 89,460.2101)/μL and (2,22,436.8421 ± 88,538.7173)/μL respectively. Mean platelet count 7days after completion of phototherapy was (2,46,210.5263 ± 87,442.3038)/μL. Decrease in platelet count just after completion of phototherapy was statistically significant. Fifty-nine (31.1%) out of 190 neonates developed mild thrombocytopenia (100000- <150000/μL) just after completion of phototherapy, but none developed moderate or severe thrombocytopenia. None having thrombocytopenia manifested with clinical bleed. Platelet count raised near to pre-phototherapy level 7 days after completion of phototherapy. Fall in platelet count was found to have a positive association with increased duration of phototherapy and lower gestational age (p<0.0001). However, there was no statistically significant association (p>0.05) between reduction in platelet count with gender. Conclusions: Though the incidence of thrombocytopenia following phototherapy was significant, but it was mostly mild and transient, and clinically insignificant. There was significant association between decrease of platelet count with duration of phototherapy and lower gestational age.

scholarly journals PLATELET COUNT IN CULTURE POSITIVE NEONATAL SEPSIS AND ITS CORRELATION WITH SPECIFIC CAUSATIVE ORGANISM- A PROSPECTIVE COHORT STUDY.

2020 ◽  
pp. 1-4
Author(s):  
Siddu Charki ◽  
Trimal Kulkarni ◽  
Vijayakumar S Biradar ◽  
S S Kalyanshettar
Keyword(s):  
Platelet Count ◽  
Total Mortality ◽  
Causative Organism ◽  
P Value ◽  
Klebsiella Pneumonia ◽  
Severe Thrombocytopenia ◽  
Gram Positive ◽  
College Hospital ◽  
Gram Negative ◽  
Culture Positive

Introduction: In neonates admitted with sepsis, thrombocytopenia is one of the common hematological problems encountered. It is commonly seen in both gram negative and gram positive septicemia. Thrombocytopenia may be considered as an important early indicator in prediction of septicemia in neonates admitted in NICU. Methods: This study was conducted in Level IIB NICU of Shri B M Patil Medical College Hospital Vijayapur, Karnataka. Study Design: Prospective Observational study was conducted. Study Duration: 1 year (Jan 2019 – Jan 2020). Inclusion Criteria: Neonates admitted in NICU with Culture Positive Sepsis were included in the study. Exclusion Criteria: Neonates with maternal history suggestive of placental insufficiency and low platelet counts and family history of bleeding disorders. Results: Out of 1250 admissions in NICU, 180 neonates had culture positive sepsis. Among 54% gram negative organisms, Klebsiella pneumonia was the commonest seen in 56% neonates. Among 40% gram positive organism MRSA was the commonest 53% neonates. Among 6% Fungal Sepsis, Candida sp. (100%) isolated. Severe thrombocytopenia was seen in 16% neonates followed by moderate thrombocytopenia (37%), mild thrombocytopenia (28%) and normal platelet count (19%). The total mortality was high (22%) in neonates having sepsis. Mortality was higher in the neonates having severe thrombocytopenia (69%) compared to neonates having moderate thrombocytopenia (30%) (P value <0.001). Klebsiella pneumoniae (60%) was the leading cause of death in the neonates with sepsis. Conclusions: Major cause of mortality in neonates with sepsis was by Gram Negative sepsis followed by Fungal and Gram Positive sepsis. Proportion of thrombocytopenia in neonates admitted with sepsis was high. Thus thrombocytopenia can be considered as one of the earliest nonspecific predictor of sepsis in neonates admitted in NICU and also it associates significantly with the outcome of the septic neonates.

Non-Invasive Management of Alloimmune Thrombocytopenia: Prediction of the Fetal Status.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3690-3690
Author(s):  
Gerald Bertrand ◽  
Moustapha Drame ◽  
Corinne Martageix ◽  
Cecile Kaplan-Gouet
Keyword(s):  
Platelet Count ◽  
Predictive Value ◽  
Conflicts Of Interest ◽  
Antibody Concentration ◽  
P Value ◽  
Severe Thrombocytopenia ◽  
Non Invasive ◽  
Predictive Parameters ◽  
Therapy Effectiveness ◽  
Alloimmune Thrombocytopenia

Abstract Abstract 3690 Fetal/neonatal alloimmune thrombocytopenia (F/NAIT) is the most common cause of severe thrombocytopenia in the fetus and the newborn in maternity wards. To counter the bleeding consequences of severe fetal thrombocytopenia, antenatal therapies have been implemented for subsequent pregnancies with incompatible fetuses. Predictive parameters for fetal severe thrombocytopenia are important for the development of non-invasive strategy and tailored intervention. We report here data concerning 67 HPA-1bb women with 81 managed pregnancies with IVIG. In 51% of the cases, the diagnosis of F/NAIT was made during the first gestation, following an intracranial haemorrhage (ICH) in 8 cases (12%). Severe thrombocytopenia was recorded for 88% of the newborn. Analysis of the index cases did not show any correlation between the severity of the disease and the maternal genetic background (ABO group and HLA-DRB3 allele). Subsequent pregnancies were managed and therapy effectiveness was evaluated. The highest mean newborn plt count was observed for a combination of intravenous immunoglobulin (IVIG) and corticoids (135.109/L; 54 newborn), in comparison with IVIG alone (89.109/L; 27 newborn). No ICH was recorded in these 2 groups. The maternal anti HPA-1a antibody concentration measured before any treatment and before 28 weeks of gestation was predictive of the fetal status: a high antibody concentration (≥28 International Units/mL) was correlated with a severe thrombocytopenia of the fetus (p=0.0016). Follow-up of the antibody concentrations during 34 pregnancies with antenatal management allowed demonstrating for the first time that the areas under curves (AUC) weighted by the weeks of gestation were a predictive parameter of therapy failure. The weighted AUC was significantly higher for women who delivered severely thrombocytopenic newborn than newborn with platelet count above 50.109/L (p=0.0107). To conclude, this large retrospective survey gives new insights on maternal predictive parameters for fetal status and therapy effectiveness allowing non-invasive strategies. Table 1: Maternal anti HPA-1a alloantibody concentrations and fetal platelet counts: statistical analysis. Predictive parameter Platelet count (×109/L) p-value Se (%) Sp (%) PPV (%) NPV (%) <50 ≥50 Number of mothers with antibody concentration (<28wg) <28 IU/mL 3 Fetuses 10 0.0016* 81.2 91.7 92.3 79.9 ≥28 IU/mL 13 2 Number of pregnancies with weighted AUC <24 IU/mL/wg 5 Newborn 18 0.0153* 64.3 82.6 69.2 79.2 ≥24 IU/mL/wg 9 5 * P<0.05. AUC: area under curve; IU: international units; Se: sensitivity, Sp: specificity; PPV: positive-predictive value; NPV: negative-predictive value. Wg: weeks of gestation. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Phototherapy in Hyperbilirubinemic Neonates; Does it Affect Platelet Count?

2016 ◽  
Vol 22 (3) ◽  
Author(s):  
Aisha Sajid ◽  
Tahir Mahmood ◽  
Sohaib Riaz ◽  
Saba Ghulam Nabi
Keyword(s):  
Platelet Count ◽  
Clinical Manifestation ◽  
Cross Sectional Study ◽  
P Value ◽  
Severe Thrombocytopenia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Unconjugated Hyperbilirubinemia ◽  
Normal Platelet ◽  
Number Of Patients

<p><strong>Objective:</strong><strong>  </strong>To determine the effect of phototherapy on platelet count in neonates having unconjugated hyperbilirubinemia.</p><p><strong>Patients and Methods:</strong><strong>  </strong>This cross sectional study was conducted in the Neonatology unit of a Hospital, Faisalabad during a period of nine months i.e., January to September 2015. All the neonates having unconjugated hyperbilirubinemia and requiring phototherapy with normal initial platelet count were included in the study. Platelet count was evaluated before the start of phototherapy and then during phototherapy at 24 hrs, 48 hrs and 72 hrs interval. Platelet counts were compared after 24, 48 and 72 hours of phototherapy. P value &lt; 0.05 was considered significant.</p><p><strong>Results:</strong><strong>  </strong>Total 150 newborns having unconjugated hyperbilirubinemia were included with mean age of 3.95 ± 1.71days. After 24 hours of phototherapy, about 8.1% of the patients were having severe thrombocytopenia (platelet count &lt; 50 ×10<sup>9</sup>/L); this percentage rose to 18.4% after 48 hours and 33.3% after 72 hours of phototherapy. None of the patients developed clinical manifestation of bleeding. The number of patients with normal platelet count (1,50 × 10<sup>9</sup>/L – 400 × 10<sup>9</sup>/L) after 24 hours of continuous phototherapy was 50%, gradually reducing  to 38% after 48 hours and only 33% after 72 hours of completion of phototherapy(p value &lt; 0.05).</p><p><strong>Conclusion:</strong><strong>  </strong>Hyperbilirubinemic neonates undergoing phototherapy had a fall in platelet count without any clinical manifestation of bleeding.</p><p> </p>

Assessment of Admission Time Cell Blood Count (CBC) Parameters in Predicting Post-primary Percutaneous Coronary Intervention TIMI Frame Count in Patients with ST-segment Elevation Myocardial Infarction

2020 ◽  
Vol 20 (3) ◽  
pp. 191-197
Author(s):  
Hossein Vakili ◽  
Isa Khaheshi ◽  
Amirsina Sharifi ◽  
Negin Nickdoost ◽  
Mohammad H. Namazi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Count ◽  
P Value ◽  
Primary Pci ◽  
Blood Samples ◽  
Timi Frame Count ◽  
Admission Time ◽  
No Reflow ◽  
Corrected Timi Frame Count ◽  
No Reflow Phenomenon

Objectives: In this study, we aimed to assess the value of admission time CBC parameters in predicting post-primary PCI corrected TIMI frame count. Background: Recent years have witnessed a large series of studies evaluating different laboratory variables to predict no-reflow phenomenon following primary PCI (PPCI) in patients with STEMI. However, a general agreement about the most reliable predictor of the no-reflow phenomenon is challenging and also intriguing. Methods: The current study concluded 208 consecutive patients who underwent primary PCI for ST-Elevation Myocardial Infarction (STEMI) from January 2014 to February 2016. Blood samples were obtained after taking ECG. Complete blood samples were collected and analyzed within 5 minutes from sampling. Post-PCI corrected Thrombolysis in Myocardial Infarction (TIMI) frame count was determined by one interventional cardiologist blinded to patients’ clinical data. The correlation between admission time blood parameters and post-primary PCI corrected TIMI frame count in patients with STEMI were assessed. Results: Corrected TIMI frame count was positively correlated with WBC count (R: 0.18, P-value: <0.01), neutrophil count (R: 0.34, P-value: <0.01), and platelet count (R: 0.23, P-value: <0.01) and negatively correlated with lymphocyte count (R: -0.2, P-value: <0.01). Multiple linear regression results demonstrated that corrected TIMI frame count was positively correlated with neutrophil count (P < 0·001) and platelet count (P < 0·001) and negatively correlated with lymphocyte count (p=0.004). Conclusion: High counts of WBC, neutrophil, and platelet and low count of lymphocyte may be predictors of no-reflow in STEMI patients undergoing PPCI. The clinical significance of such predictive parameters becomes clear as we consider the treatment approach in STEMI patients. Appropriate risk stratification leads to better treatment planning and allocation of resources.

scholarly journals Current management of cancer-associated venous thromboembolism in patients with thrombocytopenia: a retrospective cohort study

2021 ◽  
Author(s):  
Alessandro Squizzato ◽  
Silvia Galliazzo ◽  
Elena Rancan ◽  
Marina Di Pilla ◽  
Giorgia Micucci ◽  
...  
Keyword(s):  
Platelet Count ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cerebral Metastasis ◽  
Bleeding Complications ◽  
Severe Thrombocytopenia ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Current Management

AbstractOptimal management of venous thromboembolism (VTE) in cancer patients with thrombocytopenia is uncertain. We described current management and clinical outcomes of these patients. We retrospectively included a cohort of cancer patients with acute VTE and concomitant mild (platelet count 100,000–150,000/mm3), moderate (50,000–99,000/mm3), or severe thrombocytopenia (< 50,000/mm3). Univariate and multivariate logistic regression analyses explored the association between different therapeutic strategies and thrombocytopenia. The incidence of VTE and bleeding complications was collected at a 3-month follow-up. A total of 194 patients of whom 122 (62.89%) had mild, 51 (26.29%) moderate, and 22 (11.34%) severe thrombocytopenia were involved. At VTE diagnosis, a full therapeutic dose of LMWH was administered in 79.3, 62.8 and 4.6% of patients, respectively. Moderate (OR 0.30; 95% CI 0.12–0.75), severe thrombocytopenia (OR 0.01; 95% CI 0.00–0.08), and the presence of cerebral metastasis (OR 0.06; 95% CI 0.01–0.30) were independently associated with the prescription of subtherapeutic LMWH doses. Symptomatic VTE (OR 4.46; 95% CI 1.85–10.80) and pulmonary embolism (OR 2.76; 95% CI 1.09–6.94) were associated with the prescription of full therapeutic LMWH doses. Three-month incidence of VTE was 3.9% (95% CI 1.3–10.1), 8.5% (95% CI 2.8–21.3), 0% (95% CI 0.0–20.0) in patients with mild, moderate, and severe thrombocytopenia, respectively. The corresponding values for major bleeding and mortality were 1.9% (95% CI 0.3–7.4), 6.4% (95% CI 1.7–18.6), 0% (95% CI 0.0–20.0) and 9.6% (95% CI 5.0–17.4), 48.2% (95% CI 16.1–42.9), 20% (95% CI 6.6–44.3). In the absence of sound evidence, anticoagulation strategy of VTE in cancer patients with thrombocytopenia was tailored on an individual basis, taking into account not only the platelet count but also VTE presentation and the presence of cerebral metastasis.

scholarly journals Mild thrombocytopenia indicating maternal organ damage in pre‐eclampsia: a cross‐sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michinori Mayama ◽  
Mamoru Morikawa ◽  
Takashi Yamada ◽  
Takeshi Umazume ◽  
Kiwamu Noshiro ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Organ Damage ◽  
Severe Thrombocytopenia ◽  
Relative Risks

Abstract Background Currently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of < 100 × 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of < 150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count < 150 × 109/L and ≥ 100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. Methods A total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥ 150 × 109/L; mild thrombocytopenia, < 150 × 109/L and ≥ 100 × 109/L; and severe thrombocytopenia, < 100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Estimated relative risk was calculated with a Poisson regression analysis with a robust error. Results Platelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The estimated relative risks of severe thrombocytopenia were 4.46 [95 % confidence interval, 2.59–7.68] for maternal organ damage except for thrombocytopenia, 1.61 [1.06–2.45] for preterm delivery < 34 gestational weeks, and 1.35 [1.06–1.73] for neonatal intensive care unit admission. On the other hand, the estimated relative risks of mild thrombocytopenia were 0.97 [0.41–2.26] for maternal organ damage except for thrombocytopenia, 0.91 [0.62–1.35] for preterm delivery < 34 gestational weeks, and 0.97 [0.76–1.24] for neonatal intensive care unit admission. Conclusions Mild thrombocytopenia was not associated with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

scholarly journals Metastatic Breast Cancer with Extensive Osseous Metastasis Presenting with Symptomatic Immune Thrombocytopenic Purpura and Anemia: A Case Report and Review of the Literature

2015 ◽  
Vol 8 (2) ◽  
pp. 256-263 ◽  
Author(s):  
Jiaxin Niu ◽  
Teresa Goldin ◽  
Maurie Markman ◽  
Madappa N. Kundranda
Keyword(s):  
Breast Cancer ◽  
Platelet Count ◽  
Metastatic Breast Cancer ◽  
Immune Thrombocytopenic Purpura ◽  
English Literature ◽  
Metastatic Breast ◽  
Response To Therapy ◽  
Severe Thrombocytopenia ◽  
Thrombocytopenic Purpura ◽  
Immune Mediated

Background: Immune thrombocytopenic purpura (ITP) is a rare acquired bleeding disorder with an estimated incidence of 1 in 10,000 people in the general population. The association of ITP with breast cancer is an even rarer entity with very limited reports in the English literature. Case Presentation: We report a case of a 51-year-old female with no significant past medical history who presented with sudden onset of malaise, syncope, gingival bleed and epistaxis. She was found to have severe thrombocytopenia (platelet count 6,000/μl) and anemia (hemoglobin 7.2 g/dl). Her workup led to the diagnosis of metastatic ductal breast cancer with extensive bone metastasis. Bone marrow biopsy demonstrated myelophthisis which was initially thought to be consistent with her presentation of thrombocytopenia and anemia. Therefore, the patient was started on hormonal therapy for the treatment of her metastatic breast cancer. After 3 months of therapy, she did not improve and developed severe mucosal bleeding. Her clinical presentation was suspicious for ITP and immune-mediated anemia, and hence she was started on steroids and intravenous immunoglobulin. The patient had a dramatic response to therapy with normalization of her platelet count and hemoglobin within 2 weeks. Conclusion: To our knowledge, this is the first reported case of metastatic breast cancer presenting with symptomatic ITP and anemia, and both symptoms are postulated to be immune-mediated.

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