· Advances in Medical Sciences · Vol. 56 · 2011 · pp 361-365 · DOI: 10.

2478/v10039-011-0030-2
© Medical University of Bialystok, Poland

Platelet indices in SGA newborns

Wasiluk A1*, Dabrowska M2, Osada J2, Jasinska E3, Laudanski T4, Redzko S4
1 Department of Neonatology, Medical University of Bialystok, Bialystok, Poland
2 Department of Haematological Diagnostics, Medical University of Bialystok, Bialystok, Poland
3 Department of Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
4 Department of Perinatology, Medical University of Bialystok, Bialystok, Poland

* CORRESPONDING AUTHOR:
Department of Neonatology, Received 03.12.2010
Medical University of Bialystok, Poland Accepted 12.05.2011
ul. Sklodowskiej 24a, Advances in Medical Sciences
15-276 Bialystok, Poland Vol. 56 · 2011 · pp 361-365
tel. +48 85 7468498, fax +48 85 7468663 DOI: 10.2478/v10039-011-0030-2
e-mail: awasiluk@umwb.edu.pl (Alicja Wasiluk) © Medical University of Bialystok, Poland

ABSTRACT
Purpose: The current study objective was to compare blood platelet indices in full-term small-for-gestational-age newborns
(SGA) and full-term appropriate-for-gestational-age newborns (AGA).
Materials/Methods: We introduced to our study 61 SGA newborns (31 females and 30 males) and 70 eutrophic infants (32
females and 38 males). The SGA newborns were divided into two groups: those weighing less than the 5th centile: 35 infants
(16 females and 19 males) and those between the 5th and 10th centiles: 26 infants (15 females and 11 males). Platelet indices
were estimated in blood samples collected from the umbilical artery.
Results: SGA demonstrated a decreased count of blood platelets (238x103/μ) as compared with AGA (286x103/μL) , p=0.0001.
Platelet hematocrit (PTC) also showed differences in both groups (SGA=0.19% vs. AGA=0.22%; p=0.0005). Mean platelet
volume (MPV) was higher in SGA (8.25fl) as compared with AGA (7.84fl); p=0.008. Large platelet count (LPLT) was higher
in AGA 6.26% vs. SGA=4.75%; p=0.01. Platelet distribution width (PDW) was found to be nearly the same (SGA=47%,
AGA=46%). PDW was higher in SGA newborns < 5th centile (43%) as compared with SGA infants between the 5th and 10th
centiles (52%); p=0.008.
Conclusions: A decreased blood platelet count, platelet hematocrit and large metabolically active platelet count, which in
addition to reduced synthesis and excessive consumption of coagulation factors in states of hiperclotting is characteristic of
IUGR, enhances the possibility of bleeding complications and increases the risk of infections. From a clinical point of view, it
is important to take into consideration the degree of intrauterine hypotrophy during the evaluation of hemostatic disorders.

Key words: SGA, platelet indices, newborns

INTRODUCTION 10% of perinatal mortality is a consequence of intrauterine

In the neonatal period, there are physiological immunological
deficiencies and disorders of the process of hemostasis [1].
Platelets play an important role in both processes, either as
part of a non-specific immune response or as an ingredient in
the development of a blood clotting process [2, 3]. It is well
documented by authors where an interrelationship between
platelets, leucocytes and endothelial cells are presented [4].
Evaluation of platelet parameters takes on particular value
in neonates whose intrauterine development proceeded
improperly, because IUGR is an important clinical problem.
Prevalence is about 8% in the general population. It has been
shown that 52% of stillbirths are associated with IUGR and
restriction [5].
In hypotrophic newborns, the blood platelet count is found
to be decreased depending on birth weight [6,7,8]. Our interest
has been focused on the determination of blood platelet indices
in full-term hypotrophic newborns as compared with full-term
appropriate-for-gestational-age neonates. Our attention has
been directed to whether or not pregnancies complicated by
intrauterine fetal growth restriction affect platelet indices.
Data from the literature on hypotrophic neonatal platelets are
few and inconclusive [6,7,9,10].
362 Platelet indices in SGA newborns

Table 1. Indices of blood platelets in full-term SGA and euthrophic newborns.

Parameter Full-term SGA newborns x ±SD Full-term eutrophic newborns AGA x ±SD
Female + Male Female Male Female + Male
PLT (x109/L) 237.6 ± 61.4 243.1 ± 62.34 231.9 ± 60.9 285.8 ± 67.4
PCT (%) 0.19 ± 0.049 0.19 ± 0.046 0.19 ± 0.053 0.22 ± 0.058
MPV (fl) 8.25 ± 0.8 8.14 ± 0.536 8.36 ± 1.004 7.84 ± 0.68
PDW (%) 47.0 ± 10.33 48.45 ± 6.68 45.53 ± 13.05 46.0 ± 11.14
LPL T (%) 4.75 ± 2.53 5.32 ± 2.56 4.17 ± 2.39 6.26 ± 3.94

Table 2. Statistical evaluation of indices of blood platelets in full-
term SGA and euthrophic newborns.
Parameter Full-term eutrophic newborns SGA female:
AGA:Full-term SGA newborns SGA male
PLT 0.0001 NS
PCT 0.0005 NS
MPV 0.008 NS
PDW NS NS
LPL T 0.01 NS
MATERIALS AND METHODS
The aim of the study was to evaluate the number and morphotic
parameters of blood platelets in 61 SGA newborns: 31 females
and 30 males, and comparing the results obtained from the
control group of 70 eutrophic infants: 32 females and 38
males. The gestational age of all the newborns ranged from
38 to 41 weeks. SGA newborns were divided into two groups:
those weighing less than the 5th centile: 35 infants (16 females
and 19 males) and those between the 5th and 10th centiles:
26 infants (15 females and 11 males). All infants were from
normal pregnancies, born vaginally in good condition, and
their period of observation in the Department of Neonatology
and Neonatal Intensive Care proceeded correctly. The study
excluded newborns with clinically- and laboratory-confirmed
congenital infections and newborns of mothers who during the
last 10 days of gestation received antiplatelet drugs or blood
products.
Blood was collected from the umbilical artery after
the cutting of the umbilical cord, which enables sampling
enough blood without difficulty. The first volume of 0.5ml
was discarded to avoid platelet activation. The next part of
blood was collected in hematological tubes with K2EDTA.
The study was approved by the parturients and the Ethical
Committee of the Medical University of Bialystok according
to the Guidelines for Good Clinical Practice. The Technicom
H3 System was used to determine the following indices: PLT
(platelet count), MPV (mean platelet volume), PDW (platelet
distribution width), PCT (platelet hematocrit) and LPLT>20fl
(large platelet count).
To verify the normal distribution of the analyzed variables,
the Kolmogorov-Smirnov, Lilliefors and the Shapiro-Wilk tests
were used to assess normality. For the analysis of quantitative
variables without normal distribution, the nonparametric
Mann-Whitney U test and the Wald-Wolfowitz test were
used. The results were considered statistically significant at
p<0.05, a high statistical significance was p<0.01, a very high
statistical significance was p<0.001.
RESULTS
The average platelet count in newborns from pregnancies
complicated by IUGR was 237.6 ± 61.4 PLT x 109/L and
was significantly lower than the average platelet count in
the control group of eutrophic infants - 285.8 ± 67.4 PLT x
109/L (Tab. 1). Moreover, the average platelet count in the
group of hypotrophic infants of both sexes with a body weight
< 5th centile averaged 218.4 ± 59.9 PLT x 109/L and was
significantly lower than the average platelet count in the group
of SGA newborns weighing between the 5th and 10th centiles
(263.5 ± 54.35 PLT x 109/L) (Tab. 3). In the study group, there
was no statistically significant impact of gender on the number
of platelets, although the differences were evident: in female
243.1 ± 62.34 PLT x 109/L and in male 231.9 ± 60.9 PLT x
109/L (Tab. 2).
The mean platelet volume (MPV) in the group of SGA
infants averaged 8.25 ± 0.8 fl, and was statistically significantly
higher than the MPV in the group of eutrophic infants - 7.84
± 0.68 fl (Tab. 1). Distribution of MPV in the group of SGA
newborns weighing < 5th centile (8.2 ± 0.76 fl) did not differ
statistically significantly from the distribution of MPV in the
group of infants weighing between the 5th and 10th centiles (
8.31 ± 0.87 fl) (Tab. 3). In addition, gender did not statistically
significantly affect MPV in the test group (Tab. 2).
Platelet hematocrit (PCT) in the SGA newborns group
averaged 0.19 ± 0.049% and was statistically significantly lower
than the average platelet hematocrit in the group of eutrophic
newborns - 0.22 ± 0.058% (Tab. 1). PCT in the group of SGA
newborns weighing < 5th centile averaged 0.18 ± 0.057% and
was statistically significantly lower than the average platelet
hematocrit in the group of SGA newborns weighing between
the 5th and 10th centiles (0.2 ± 0.031%) (Table 3). Statistically
significant differences in PCT were not achieved in the group
of SGA female newborns (0.19 ± 0.046%) compared with
SGA male newborns (0.19 ± 0.053%) (Tab. 2).
Wasiluk A et al.
Table 3. Indices of blood platelets and statistical evaluation in full-term SGA newborns < 5th centile and between the 5th and 10th
centiles.
Parameter Full-term SGA newborns
<5th centile
Female + Male
PLT 218.4 ± 59.9
PCT 0.18 ± 0.057
MPV 8.2 ± 0.76
PDW 43.44 ± 11.24
LPL T 4.91 ± 2.65
Distribution of the platelet index of anisocytosis PDW
in the group of SGA infants (47.0 ± 10.33%) did not differ
statistically significantly from the distribution of the platelet
index of anisocytosis in the group of eutrophic newborns
(46.0 ± 11.14%) (Tab. 1). The PDW of the SGA newborns
with a body weight < 5th centile averaged 43.44 ± 11.24% and
was statistically significantly lower than the average PDW of
the SGA infants weighing between the 5th and 10th centiles
(51.82 ± 6.51%) (Tab. 3). In the study group, there was no
statistically significant impact of gender on the platelet index
of anisocytosis (Tab. 2).
The number of large platelets LP in the group of SGA
infants averaged 4.75 ± 2.53% and was statistically significantly
lower than the average number of large platelets in the group
of eutrophic infants - 6.26 ± 3.94% (Tab. 1). Distribution of the
number of large platelets LP in the group of SGA newborns of
both sexes with a body weight < 5th centile (4.91 ± 2.65%)
did not differ statistically significantly from the distribution of
the number of large platelets in the group of infants weighing
between the 5th and 10th centiles (4.54 ± 2.39%) (Tab. 3). In
the study group of SGA newborns, there was no statistically
significant impact of gender on the number of large platelets,
although the differences were evident: 5.32 ± 2.56% in female
and 4.17 ± 2.39% in male (Tab. 2).
DISCUSSION
SGA newborns tend to be more prone to coagulation
disturbances compared with AGA neonates which results in
hypofunction of the platelets [11]. The study showed that the
average number of platelets in SGA newborns was significantly
lower than the average platelet count in the control group of
eutrophic infants, and the severity of hypotrophy reduces their
number.
The reduced number of platelets in SGA neonates may be
the result of an impaired thrombopoiesis process due to the
limited maturity of the organs responsible for this process.
The original location of this process is the liver and the
spleen [12]. SGA newborns with IUGR are characterized by
a decrease in abdominal circumference, which is the result of
the redistribution of blood to the brain resulting in impaired
development of the internal organs [13].
363
Full-term SGA newborns Full-term SGA newborns
>5th and <10th <5th : >5th and <10th
Female + Male
263.5 ± 54.35 0.03
0.2 ± 0.031 0.04
8.31 ± 0.87 NS
51.82 ± 6.51 0.008
4.54 ± 2.39 NS
We can assume that this phenomenon is responsible for the
reduced number of megakaryocyte precursor cells in the original
locations of thrombopoiesis and then in the bone marrow.
Hiett et al. [14], by comparing the number of hematopoietic
progenitor cells in the cord blood of AGA newborns and SGA
infants, found lower values in SGA newborns, which may
indicate an impaired process of megakariopoiesis.
The phenomenon of IUGR can result from placental
dysfunction and vasculopathy, which are accompanied by
excessive clotting associated with an increased consumption
of platelets.
The most important factor in stimulating the formation
of platelets is thrombopoietin, whose principal place of
synthesis in newborns and fetuses is the liver. Thrombopoietin
acts through the c-MPL receptor present on platelets,
megakaryocytes and precursor cells of megakariopoiesis,
and its plasma concentration depends on the amount of
free receptor c-MPL. When the platelet count increases, a
significant proportion of circulating TPO binds to the receptor
c-MPL, resulting in a decrease of free TPO, and inhibits
thrombopoiesis. When the platelet count falls, more freely
circulating plasma thrombopoietin stimulates thrombopoiesis
[15]. Recent studies in the literature on thrombopoietin levels
in neonates have been conducted by Wasiluk et al. [16], who
found higher levels of thrombopoietin in SGA newborns. They
assumed that the increase in TPO levels in SGA newborns is
the result of disturbances in the process of megakariopoiesis.
We also know that increasing levels of thrombopoietin occur
in states of hypoxaemia, which often coexist with IUGR [16].
Chronic hypoxaemia is linked to the phenomenon
of policytemia. The platelet count cannot be increased
since hypoxaemia stimulates erythropoiesis more than
thrombopoiesis [14]. Numerous studies [17,18] found higher
values of erythrocytes, hemoglobin and hematocrit in SGA
neonates. Interesting results were obtained by Soothill [19],
who examined blood collected during cordocentesis of
fetuses from pregnancies complicated by IUGR. He found
an increased number of erythroblasts in the blood of SGA
fetuses. Some authors [20,21] also provide information on
more mononuclear forms of erythrocytes in SGA newborns.
An increase in the number of those cells in SGA newborns
indicates the intensity of erythropoiesis in fetal life, which is
the cause of a reduction of the synthesis of leukocyte cells and
364
platelets in neonates from pregnancies complicated by IUGR.
A confirmation of this hypothesis can be Greene’s
study [22], which concluded that the increased number of
erythroblasts in the blood of SGA infants was accompanied
by a reduction in the number of leukocytes, granulocytes and
platelets. We can assume that the phenomenon of policytemia
is one of the reasons of a reduction in the platelet count in SGA
newborns.
An explanation for the higher values of platelet volume
(MPV) in SGA newborns may be a known dependence
according to which the platelet count is inversely proportional
to their size (the larger the number of platelets, the lower
their average volume) [23]. Thus obtained MPV results are
consistent with the number of platelets in the tested groups of
children.
Platelet hematocrit in eutrophic newborns is elevated
(compared with SGA infants) in relation to the platelet count,
which is higher in AGA newborns.
It was found that the severity of intrauterine hypotrophy
influences the impairment of the trombopoiesis process
which results from the reduced values of the platelet index of
anisocytosis PDW and decreases along with the drop in the
birth weight of SGA infants. The platelet index of anisocytosis
was higher in the group of SGA newborns in the less than
5th centile (43%) as compared with SGA infants between the
5th and 10th centiles (52%); p=0.008. PDW may be useful in
early detection of such pathological conditions as bacteremia,
schistocytosis, platelet consumption or aggregation [24]. PDW
as high as 75% indicates bacteremia [25], and an increase in
the platelet index of anisocytosis is also found in parasitic
infections [26]. From a clinical point of view, assessment
of hemostatic disorders in SGA newborns should reflect the
degree of intrauterine hypotrophy.
Lower values of large platelets LPLT in hypotrophic
newborns show that the process of thrombopoiesis is not
fully functional in newborns from pregnancies complicated
by IUGR. The number of large platelets is an important
parameter serving not only to evaluate hemostasis but also
other functions such as phagocytosis of platelets, since they
present high metabolic activity [27]. Reducing the number of
LPLT in SGA newborns may indicate a greater susceptibility
of this group of newborns to infections.
Platelet counts and their parameters do not show evident
differences according to the sex of the SGA newborns. In the
studied SGA newborns, a statistically significant difference in
PLT, MPV and LPLT counts occurred in comparison with the
control group.
CONCLUSIONS
The obtained results show that thrombopoiesis in SGA
newborns is impaired. This leads to a reduction in the number
of thrombocytes and large metabolically active platelets, which
Platelet indices in SGA newborns
in addition to reduced synthesis and excessive consumption
of coagulation factors in states of hiperclotting characteristic
for IUGR, enhances the possibility of bleeding complications
and increases the risk of infections. Additionally, it has been
demonstrated that the degree of severity of intrauterine growth
retardation influences the impairment of thrombopoiesis,
which results from the reduced value of the platelet index
of anisocytosis PDW with a decrease in the birth weight of
SGA infants. From a clinical point of view, it is important to
take into consideration the degree of intrauterine hypotrophy
during an evaluation of hemostatic disorders.
ACKNOWLEDGEMENTS
The study was approved by the parturients and the Ethical
Committee of the Medical University of Bialystok, according
to the guidelines for Good Clinical Practice, permission
number R-I-002/53/209.
REFERNCES
1 Maconi M, Rolfo A, Cardaropoli S, Brini M, Danise
P. Hematologic values in healthy and small for gestational age
newborns. Lab Hematol. 2005;11(2):152-6.
2 von Hundelshausen P, Weber C. Platelets as immune
cells: bridging inflammation and cardiovascular disease. Circ
Res. 2007 Jan 5;100(1):27-40.
3 Andrews RK, Berndt MC. Platelet adhesion: a game
of catch and release. J Clin Invest. 2008 Sep;118(9):3009-11.
4 Andrews RK, Berndt MC. Microparticles
facilitate neutrophil/platelet crosstalk. Blood. 2008 Sep
15;112(6):2174-5.
5 Mandruzzato G, Antsaklis A, Botet F, Chervenak FA,
Figueras F, Grunebaum A, Puerto B, Skupski D, Stanojevic
M; WAPM. Intrauterine restriction (IUGR). J Perinat Med.
2008;36(4):277-81.
6 Maconi M, Rolfo A, Cardaropoli S, Brini M, Danise
P. Hematologic values in healthy and small for gestational age
newborns. Lab Hematol. 2005;11(2):152-6.
7 Ozyürek E, Cetintaş S, Ceylan T, Oğüş E, Haberal
A, Gürakan B, Ozbek N. Complete blood count parameters for
healthy, small-for-gestational-age, full-term newborns. Clin
Lab Haematol. 2006 Apr;28(2):97-104.
8 Krajewski P, Pokrzywnicka M, Kwiatkowska
M. Analysis of selected coagulation parameters and blood
platelets count in extremely intrauterine growth restricted
(IUGR) newborns. Arch Perinat Medicine 2009;15(1):35-40.
9 Hannam S, Lees C, Edwards RJ, Greenough A.
Neonatal coagulopathy in preterm, small-for-gestational-age
infants. Biol Neonate. 2003;83(3):177-81.
10 Ali MA, Shahidullah M, Hossain MA, Ahmed NU,
Kawsar CA. Comparison of haematological values among
different groups of low birth weight babies and normal birth
weight babies. Mymensingh Med J. 2008 Jul;17(2):152-6.
Wasiluk A et al.
11 Saxonhouse MA, Sola MC. Platelet function in term
and preterm neonates. Clin Perinatol. 2004 Mar;31(1):15-28.
12 Ferrer-Marin F, Liu ZJ, Gutti R, Sola-Visner M.
Neonatal thrombocytopenia and megakaryocytopoiesis. Semin
Hematol. 2010 Jul;47(3):281-8.
13 Falo AP. Intrauterine growth retardation (IUGR):
prenatal diagnosis by imaging. Pediatr Endocrinol Rev. 2009
Feb;6 Suppl 3:326-31.
14 Hiett AK, Britton KA, Hague NL, Brown HL,
Stehman FB, Broxmeyer HE. Comparison of hematopoietic
progenitor cells in human umbilical cord blood collected from
neonatal infants who are small and appropriate for gestational
age. Transfusion. 1995 Jul;35(7):587-91.
15 Kaushansky K. The molecular mechanisms
that control thrombopoiesis. J Clin Invest. 2005
Dec;115(12):3339-47.
16 Wasiluk A, Mantur M, Kemona H, Szczepański
M, Jasińska E, Milewski R. Thrombopoiesis in small for
gestational age newborns. Platelets. 2009 Nov;20(7):520-4.
17 Maconi M, Rolfo A, Cardaropoli S, Brini M, Danise
P. Hematologic values in healthy and small for gestational age
newborns. Lab Hematol. 2005;11(2):152-6.
18 Ozyürek E, Cetintaş S, Ceylan T, Oğüş E, Haberal
A, Gürakan B, Ozbek N. Complete blood count parameters for
healthy, small-for-gestational-age, full-term newborns. Clin
Lab Haematol. 2006 Apr;28(2):97-104.
19 Soothill PW, Nicolaides KH, Campbell S.
Prenatal asphyxia, hyperlacticaemia, hypoglycaemia, and
erythroblastosis in growth retarded fetuses. Br Med J (Clin
Res Ed). 1987 Apr 25;294(6579):1051-3.
365
20 Axt-Fliedner R, Hendrik HJ, Wrobel M, Friedrich
M, Schmidt W. Significance of high and normal neonatal
nucleated red blood cell count in small-for-gestational-age
newborns. Clin Exp Obstet Gynecol. 2002;29(1):49-53.
21 Bernstein PS, Minior VK, Divon MY. Neonatal
nucleated red blood cell counts in small-for-gestational age
fetuses with abnormal umbilical artery Doppler studies. Am J
Obstet Gynecol. 1997 Nov;177(5):1079-84.
22 Green DW, Elliot K, Mimouni FB. Hematologic
profiles of preterm multiples with IUGR. Pediatric Research
1998;43(4):237.
23 Dąbrowski Z. Fizjologia krwi. PZWL Warszawa
2000 137-43 p.
24 Wasiluk A, Osada J, Dabrowska M, Szczepański M,
Jasinska E. Does prematurity affect platelet indices? Adv Med
Sci. 2009;54(2):253-5.
25 Patrick CH, Lazarchick J. The effect of bacteremia
on automated platelet measurements in neonates. Am J Clin
Pathol. 1990 Mar;93(3):391-4.
26 Kralisz M, Matowicka-Karna J. Evaluation of
morphological parameters of blood platelets in the course of
giardiasis. Pol Merkur Lekarski. 2008 Dec;25(150):480-3.
Polish.
27 Bavbek N, Kargili A, Kaftan O, Karakurt F, Kosar
A, Akcay A. Elevated concentrations of soluble adhesion
molecules and large platelets in diabetic patients: are they
markers of vascular disease and diabetic nephropathy? Clin
Appl Thromb Hemost. 2007 Oct;13(4):391-7.