Pediatric Drug Induced Thrombocytosis

Essential thrombocytosis is very rare in neonates, and most cases of high platelet counts in pediatric patients are due to secondary thrombocytosis. One of the main causes of secondary thrombocytosis in neonates is maternal narcotic drug abuse during pregnancy. Nonetheless, The impact and management of neonatal thrombocytosis are not very well studied yet.

Below are examples of 2 cases that are related to secondary thrombocytosis:

Case 1: A schizophrenic mother who was treated with non-narcotic psychotropic drugs during pregnancy gave birth to a baby suffering from severe prolonged thrombocytosis. Laboratory data revealed platelet count value of 1310 × 10⁹/l on day 15 of his life, and the patient was treated with dipyridamole. His platelet count returned to normal after several months. A bone marrow aspirate was performed to evaluate his disease state. The patient had an increased level of megakaryocytes and normal myeloid and erythroid precursors. In addition, Plasma concentrations of interleukin 6 and thrombopoietin were suppressed. The patient didn’t show any sign of complication from thrombocytosis. 

                                 Figure 1: Plasma platelet counts, thrombopoietin, and interleukin 6 (IL6) concentrations of the patient

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Case 2: A 14 days old neonate diagnosed with withdrawal syndrome was admitted to the intensive care unit. He presented very high platelet value of 1168 × 10⁹/l  in the first day of admission, which gradually decreased to 739 × 10⁹/l in a period of 28 days. Upon history investigation, the mother admitted that she was a heroin addict and used methadone during pregnancy.

These cases indicate that thrombocytosis may occur in infants born to mothers treated with non-narcotic psycho-pharmaceutical drugs during pregnancy, as well as mothers who are taking narcotics during pregnancy, and caution is to be considered during treatment of pregnant females. In most similar cases, thrombocytosis goes away in the babies with no severe complications, unless in the presence of bone marrow anomaly.