Thrombocytopenia in Newborns

Jagdish Kathwate
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Thrombocytopenia In Newborns - Patient Education
What is thrombocytopenia?
Thrombocytopenia is the term for a reduced platelet (thrombocyte) count.The normal level is 140 – 400 x 10 (9) / l, but minor fluctuation is common and investigation is not usually necessary if the count is above 100 x 10 (9) /l and the patient has no symptoms.
What are causes of low Platelets in newborn babies?
Neonatal thrombocytopenia is defined as a platelet count of less than 150 x 109/l. The hallmark of platelet disorders is mucocutaneous bleeding however newborns may present more severely with, petechiae, purpura, and intra-cranial hemorrhages
Causes of thrombocytopenia are best separated by time of presentation into fetal, early <3 days) and late.
Timing Common Aetiology Less Common Aetiology
Fetal
Alloimmune
Congenital infection (e.g. CMV, toxoplasma, rubella)
Aneuploidy (e.g. trisomies 18, 13, 21, or triploidy)
Autoimmune (e.g. ITP, SLE) Severe rhesus disease
Congenital/inherited (e.g. Wiskott-Aldrich syndrome)
Early-Onset Neonatal
(<72 hours) Placental insufficiency (e.g. GPH, IUGR, diabetes)
Perinatal asphyxia
DIC
Alloimmune
Autoimmune Congenital infection (e.g. CMV, toxoplasma, rubella)
Thrombosis (e.g. aortic, renal vein)
Bone marrow replacement (e.g. congenital leukaemia)
Kasabach-Merritt syndrome
Metabolic disease (e.g. propionic and methylmalonic acidaemia)
Congenital/inherited (e.g. TAR, Congenital Amegakaryocytic Thrombocytopenia [CAMT])
Late-Onset Neonatal
Late-onset sepsis
NEC Congenital infection (e.g. CMV, toxoplasma, rubella)
Autoimmune

What is treatment for low platelets Platelet Transfusion Guideline
Many centres have developed consensus-based guidelines for platelet transfusion while awaiting strong evidence for timing of intervention.
Platelet Count (x109) Action
<30 1. Transfuse if bleeding
2. Consider transfusion in all other cases
30-49 1. Transfuse if bleeding
2. Consider transfusion if:
1. <1000g and <7 days
2. Clinically unstable (e.g. fluctuating BP)
3. Previous major bleeding (e.g. Grade 3-4 IVH, pulmonary haemorrhage)
4. Current minor bleeding
5. Concurrent coagulopathy
6. Requiring surgery or exchange transfusion
50-99 1. Transfuse only if bleeding
>99 1. Do not transfuse


References
Thrombocytopenia in Newborns Thrombocytopenia in Newborns 08/01/2015
<< Treatment of Neonatal Immune Thrombocytopenia
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