Abstract

Thrombocytopenia (defined as a platelet count <150×109/L) is a common condition in preterm neonates and may occur in 18-35% of all infants admitted to the Neonatal Intensive Care Unit (NICU). Neonatal platelet functionality in terms of reactivity is often described as reduced compared to adults, even in healthy, term neonates. However, this platelet “hyporeactivity” does not correspond to a global functional impairment of the normal delicately balanced neonatal hemostatic system. The extent to which neonatal thrombocytopenia and platelet hyporeactivity contribute to the bleeding risk in preterm neonates remains unknown. Prophylactic platelet transfusions are often administered to them to reduce the risk of bleeding. However, recent literature indicates that adopting a higher platelet transfusion threshold than a lower one results in significantly higher death rates or major bleeding and can be harmful. Although the mechanism by which this occurs is not entirely clear, a mismatch between adult transfused platelets and the neonatal hemostatic system, as well as volume overload, are speculated to be potentially involved. Therefore, future research should consider novel transfusion products that may be more suitable for premature neonates. Blood products derived from umbilical cord blood (UCB) are promising, as they might perfectly match neonatal blood features. Here, we discuss the current knowledge about UCB-derived products, focusing on UCB-derived platelet concentrates and their potential for future clinical application. We will discuss how they may overcome the potential risks of transfusing adult-derived platelets to premature infants while maintaining efficacy.

Downloads

Authors

Valeria Cortesi - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy https://orcid.org/0000-0003-2083-411X

Giacomo Cavallaro - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy https://orcid.org/0000-0002-4921-1437

Genny Raffaeli - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy https://orcid.org/0000-0001-9175-9394

Stefano Ghirardello - Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy https://orcid.org/0000-0002-0621-155X

Fabio Mosca - Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy https://orcid.org/0000-0001-6477-0299

Thomas R.L. Klei - Department of Product and Process Development, Sanquin Blood Supply, Amsterdam, the Netherlands https://orcid.org/0000-0002-2864-4073

Susanna Fustolo-Gunnink - Sanquin Blood Supply Foundation, Amsterdam, the Netherlands; Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands https://orcid.org/0000-0002-1607-2581

Simon Stanworth - Department of Hematology, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom https://orcid.org/0000-0002-7414-4950

Helen V. New - Clinical Directorate, NHS Blood and Transplant, London, United Kingdom https://orcid.org/0000-0001-6290-8004

Emöke Deschmann - Department of Neonatology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

Enrico Lopriore - Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands https://orcid.org/0000-0002-3513-5066

  • Abstract viewed - 82 times
  • pdf downloaded - 129 times