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LIONEL

Anti platelet agents in thrombocytosis - anyone with experienced?

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Posted (edited)

Hello, anyone experienced with use of Anti platelets agents in persistent thrombocytosis in Low birth weight, very low birth weight, low birth weight and term babies?

Edited by Stefan Johansson
Title edit and topic moved to Hematology

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What degree of thrombocytosis are you concerned about and what is your goal?  I admit to having no experience in ordering anti platelet agents neonates, but I must also say I cannot think of a circumstance in which thrombocytosis would lead me to want to administer an anti platelet agent ....

Can you provide more clinical context?

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Hello, I am dealing with a 12 day old male neonate,term baby, HIV unexposed,born via Spontaneous vaginal delivery with good Apgar score, and BWT:2950G,was brought in My Unit for Phototherapy because the Total Bilirubine was 376 Umol/l, prior to admission CBC and Blood culture taken CBC: WBC(N),HGB: 14.7g%,PLT:785, Repeated after 48 hours, PLT:865, 72HRS later 978, Patient clinically stable and completed 6 days IV Antibiotics( Ampi + Gentamycin), What could be the cause of this progressive Thrombocytosis and what are the therapeutic measures if we have to think of any Anti platelets Agents.

Your comments are all welcome.

 

DR LIONEL NKULU

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https://pdfs.semanticscholar.org/82f2/72696e66a81605427eafadd87d307573d4b1.pdf

In general, thrombocytosis in neonates is reactive.  Above is a case series emphasizing this point.  Almost anything that stresses the marrow and/or induces hypoxia can cause thrombocytosis.  Treatment should be directed at the underlying cause, NOT the platelets themselves.  If you remove the stressor on the marrow, the platelet count will improve.  As the case series above attests, clinically meaningful thrombotic events are exceedingly uncommon even at quite high platelet counts and, in fact, hemorrhagic occurrences are more common in this age group.  I would not pursue anti platelet therapy unless I had evidence of meaningful clot burden and even then I would very carefully consider the relative risks and benefits of ant platelet or anticoagulant therapy.

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