Level, Timing, and Duration of Thrombocytopenia as a Risk Factor for the Development of Severe ROP in the Postnatal Growth and ROP (G-ROP) Study
Alejandra G. de Alba Campomanes; Anne K. Jensen; Gui-shuang Ying; Lauren A. Tomlinson; Gil Binenbaum;
G-ROP Study Group
Department of Ophthalmology, University of California, San Francisco. The Children’s Hospital of Philadelphia, Philadelphia PA, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
San Francisco, CA; Philadelphia PA
Introduction: Identification of modifiable risk factors for retinopathy of prematurity (ROP) may lead to preventive or therapeutic targets. Beyond hemostasis, platelets store, transport, and deliver VEGF and IGF-1, which are both involved in ROP pathogenesis.
Purpose: To evaluate the association between degree, timing, and duration of thrombocytopenia and severe ROP.
Methods: Retrospective study at 29 North-American hospitals, 2006-2012 (The G-ROP Study). Multivariable regression evaluated associations between thrombocytopenia and type 1/2 ROP, controlling for birth-weight, gestational age, necrotizing enterocolitis, sepsis. Mean platelet levels and proportions of infants with thrombocytopenia (defined three ways: </=150,000, </=100,000, </=50,000/mcl) were compared. Onset and thrombocytopenia duration were evaluated.
Results: 7,238 infants studied, 917(12.7%) developed severe ROP. Mean platelets were significantly lower and proportions with thrombocytopenia at each level (</= 150k/</=100k/</=50k) were significantly higher in infants with severe ROP during each PMA-week 25-40. Proportions of infants with/without severe ROP with thrombocytopenia by 34 weeks PMA were 72%/34% (</=150k), 46%/15% (</=100k), 14%/3% (</=50k)(all p<0.0001). Corresponding aORs(95% CI), were 1.63(1.36-1.96),1.62(1.33-1.96),1.68(1.14-2.48). 86% infants who had platelets </=50K by PMA-week 27 developed severe ROP (aOR 4.97). Increasing thrombocytopenia duration during PMA-weeks 29-34 was associated with increasing aOR(1.5-3), but even 1-week duration was associated with increased risk, especially for </=50k level.
Discussion: Thrombocytopenia with onset prior to 34-weeks PMA is independently associated with severe ROP, even for levels above those considered as bleeding risk, and short time periods. Low serum platelet levels increase risk of severe ROP.
Conclusion: Low serum platelet levels increase risk of severe ROP. Further study of these associations and the potential of platelet transfusions as a preventive intervention to reduce ROP risk are warranted.
References: 1. Jensen AK, Ying GS, Huang J, Karp K, Quinn GE, Binenbaum G. Thrombocytopenia and retinopathy of prematurity.J AAPOS. 2011 Feb 1;15(1):e3-e4
2.Binenbaum G, Tomlinson LA. Postnatal Growth and Retinopathy of Prematurity Study: Rationale, Design, and Subject Characteristics. Ophthalmic Epidemiol. 2017 Feb;24(1):36-47