Incidence of thrombocytopenia in hyperbilirubinemic neonates following Phototherapy
Dr. Bhargava Omprakash1, Dr. Sutrakar Suresh Kumar2,*, Dr. Ghanghoria Pawan3, Dr. Verma Arvind4
1Assistant Professor, Department of Pathology, N.S.C.B. Medical College, Jabalpur (M.P) India-482001
2Associate Professor, Department of Pathology, S.S. Medical College and Asso. S.G.M. Hospital, Rewa (M.P.) India-486001
3Associate Professor, Department of Pediatrics, Netaji Subhas Chandra Bose Medical College, Jabalpur (M.P.) India-458003
4Medical Officer, District Hospital, Mandsaur (M.P.) India -458001
*Corresponding Author E-mail: firstname.lastname@example.org
Online published on 25 June, 2015.
Thrombocytopenia has not been conclusively reported as a complication of phototherapy in any of the standard paediatric textbooks. A prospective study was conducted in the Department of Paediatrics and Department of Pathology in Netaji Subhash Chandra Bose Medical College and associated Hospital, Jabalpur, Madhya Pradesh (India) between August 2009 and August 2010; in consecutively enrolled apparently healthy neonates, who developed indirect hyperbilirubinaemia and required phototherapy irrespective of gestational age and birth weight and platelet counts. The indication of phototherapy was based on IAP-NNF guidelines 2006 on level II Neonatal care:American Academy of Pediatrics 2006. Neonates having congenital porphyria or a family history of porphyria, conjugated hyperbilirubinaemia and receiving concomitantantly drugs or agents that are photosensitizers were not included in the study. Platelet counts were performed at the time of admission, (at the initiation of phototherapy), after 48 hours, and 96 hours of phototherapy.
Out of 96 neonates included in study 67(69.8 percent) were male and 29(30.2 percent) were female. At the initiation of phototherapy 35 (36.5 percent) neonates were having platelet count above 150000/cumm while after 48 hours of phototherapy 76 (79.2 percent) neonates were having platelet count below 150000/cumm. Majority of neonates had mild (58.2 percent) and moderate (20.8 percent) thrombocytopenia during the first 48 hours of phototherapy. Mean platelet count is also taken into consideration in correlation with gestational age, weight, income, postnatal age and mode of delivery, which is always> 150000/cumm at the initiation of therapy and < 150000/cumm after 48 hours of therapy, usually was not associated with clinical bleed. This study establishes an association of phototherapy as a cause of thrombocytopenia in hyperbilirubinaemic neonates. Though the incidence of thrombocytopenia is substantial yet it is clinically insignificant. This study helps the practitioner to be aware of this association and avoid unnecessary investigations, as thrombocytopenia was transient.
Indirect hyperbilirubinaemia, Neonatal thrombocytopenia, Phototherapy.