Researchers at WEHI (Walter and Eliza Hall Institute) have discovered a new method to help identify infants and fetuses at high risk of developing brain bleeds, paving the way for better early intervention.
Brain bleeds in unborn babies and newborns can lead to stroke and permanent neurological conditions, such as cerebral palsy.
While brain bleeds can sometimes be treated with platelet transfusions, invasive procedures can be dangerous, and it was not clear which infants would benefit most.
at a glance
- Research has discovered a new way to help identify unborn and newborn babies at risk for brain bleeds.
- Preclinical studies suggest that if platelet levels drop to 10 percent or less in fetuses and newborns, the brain will bleed.
- The new threshold can be used to determine which children should be treated, changing platelet transfusion practices and avoiding unnecessary procedures.
WEHI researchers Dr Alison Farley and Dr Samir Taudi are investigating how levels of platelets, the small blood cells best known for enabling blood clots, affect brain bleed. To understand correctly when platelet transfusion should be deployed.
A new analysis of preclinical models has found that brain bleeds always occur when platelet levels drop to 10 percent or less in newborns and fetuses.
Research also indicates that babies may develop protection against brain bleeds two weeks after birth, with very low platelet levels not bleeding after this age.
published in BloodThis study paves the way for a better understanding of which infants should receive platelet transfusions and where the platelet threshold can be set to avoid unnecessary blood transfusions.
Low platelet levels, a condition called thrombocytopenia, can be associated with excessive bleeding and is common in premature infants.
By analyzing varying degrees of thrombocytopenia in pre-clinical models, the researchers were able to isolate three levels of platelet count that determined the risk of brain hemorrhage.
They found that unborn or newborn babies are guaranteed a brain bleed if their platelet count drops to 10 percent or less.
While a moderate platelet level between 10-40 percent could potentially trigger a brain bleed, babies with more than 40 percent of platelets were at absolutely no risk of developing the condition.
“Currently platelet transfusions are given to middle-aged children who may not even experience brain bleeds,” said Dr. Farley.
“Working on the threshold of platelet levels that always bleed through the brain, and limits that may not, is important.
“Our findings may help determine which babies can safely receive platelet transfusions after birth, and where the threshold can be lowered to avoid unnecessary and risky transfusions.
“If the loss of platelets occurs within a few days after birth, it may offer a window for potential intervention, preventing severe brain hemorrhage and stroke in infants.”
Samir Taudi said an important next step would be to analyze protection against brain bleeds two weeks after birth, as well as to test which proteins and genes are involved.
“We need to see how, or even if, platelets and the blood vessels of the brain work together to build up the resistance to brain bleeds,” Taudi said.
“Our next big challenge is to understand whether brain bleeds are caused by a breakdown in communication between platelets and blood vessels, or if they are triggered by environmental factors?”
reference: Farley AM, Dayton M, Biben C, Stonehouse O, Terreux A, Taudi S. Cerebral vasculature exhibits dose-dependent susceptibility to thrombocytopenia that is limited to fetal/neonatal life. Blood, 2022;139(15):2355-2360. doi: 10.1182/blood.2021014094
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