Diseases and Conditions › Pediatric Hematology › Thrombocytopenia In Newborns

Thrombocytopenia In Newborns

Jagdish Kathwate

MD Pediatrics. Assistant Professor, Government Medical College, Aurangabad, India.
First Created: 02/13/2001 Last Updated: 08/01/2015

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Thrombocytopenia is the term for a reduced platelet (thrombocyte) count. The normal level is 140-400 x 10⁹/l, but minor fluctuation is common and the investigation is not usually necessary if the count is above 100 x 10⁹ /l and the patient has no symptoms.

What are the 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 intracranial 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 centers have developed consensus-based guidelines for platelet transfusion while awaiting strong evidence for the timing of intervention.

Platelet Count (x109) Action

<30

Transfuse if bleeding

Consider transfusion in all other cases

30-49

Transfuse if bleeding

Consider transfusion if:
- <1000 g and <7 days
- Clinically unstable (e.g. fluctuating BP)
- Previous major bleeding (e.g. Grade 3-4 IVH, pulmonary haemorrhage)
- Current minor bleeding
- Concurrent coagulopathy
- Requiring surgery or exchange transfusion

50-99

Transfuse only if bleeding

>99

Do not transfuse

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