Thrombocytopenia In Newborns

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

Patient Education

What is thrombocytopenia?

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



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



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)


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


  • Transfuse if bleeding
  • Consider transfusion in all other cases


  • 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


  • Transfuse only if bleeding


  • Do not transfuse

1. Andrew M. Hemostatic system in the infant. In : Nathan DG & Oski FA (eds). Hematology of Infancy and Childhood, 4h edn, WB Saunders, 1993.
2. Andrew M, Paes B et al. Development of human coagulation system in the full term infants. Blood 1987, 70: 165.
3. Anderew M, Paes B, Johnson M. Development of hemostatic system in neonate and young infants. Pediatr Hematol-Oncol 1999,12:95.
4. Andrew M, Paes B et al. Human coagulation system in the healthy development of premature infants. Blood 1988, 72: 165.
5. Aballi A, de ham derens's S. Coagulation changes in the neonatal period and in early infancy. Pediatr Clin North Am 1962, 9: 785.
6. Aballi A, Puapondh Y, Desposito F. Platelet count in the thriving premature infants. Pediatr 1968, 42: 685.
7. Burrows RF, Keltan J. Foetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med 1993, 1463-1466.
8. Radley JM, Scurrfield G. Mechanism of platelet release. Blood 1980, 56: 996.
9. Arade ID, Alpog et al the mean platelet volume (MPV) in the neonatal period. Am J Perinatol 1986, 3: 1.
10. Vanden Hol MC, Nicolaides KH. Platelet count in normal, small anemic fetuses. Am J Obstet Gynaecol 1990, 162: 735.
11. Burrows RF, Kelton G. Thrombocytopenia at delivery survey of 6715 deliveries. Am J Obstet Gynaecol 1990, 162: 731-4.
12. Burrows RF, Kelton JG. Incidentally detected thrombocytopenia in healthy mother and infant. N Engl J Med 1988, 319: 142-5.
13. Uhrynowska M, Maslanka K, Zupanska B. Neonatal thrombocytopenia - Incidence, serological and clinical observations. Am J Periantol 1997, 14: 415.
14. Gill FM. Thrombocytopenia in the newborn. Semin Perinatol 1983, 7: 201.
15. Dreyfus M, Kaplan C, Verydy E et al. Frequency of immune thrombocytopenia in newborns : A prospective study. Blood 1997, 89: 4402.
16. Martha C Sola Antonio Del Vecchio, Lisa Rimsza. Evaluation and treatment of thrombocytopenia in the neonatal intensive care unit. Clinics in Perinatol 2000, 27: 655-679.
17. Martha C Sola and Robert Christensen. Developmental aspect of platelets and disorders of platelets in neonatal period in hematologic problems of the neonate. RD Christein, WB Saunders Co, Philadelphia, Pp. 273-309.
18. Castle V, Andrew M, Kelton J et al. Frequency and mechanism of neonatal thrombocytopenia. J Pediatr 1986, 108: 749.
19. Mehta P, Vasa R, Neumann L et al. Thrombocytopenia in the high risk infant. J Pediatr 1980, 71: 769.
20. Oren H, Irkan G, Oren B et al. Assessment of clinical impact and predisposing factor for neonatal thrombocytopenia. Indian J Pediatr 1994, 61: 551-558.
21. Allen Graeve JL, de Alarcon PA. Megakaryocytopoiesis in human foetus. Arch Dis Child 1989, 64: 481.
22. Sola MC, Calhoun DA, Hutson AD et al. Plasma thrombopoietic concentrations in thrombocytopenic neonates and non-thrombocytopenic neonates in a neonatal intensive care unit. Br J hematol 1999, 104: 90.
23. Murray NA, Roberts IAG - Circulating megakaryocytes and their progenitors in early thrombocytopenia in preterm neonates. Pediatr Res 1996, 40: 117.
24. McCrac KR, Samuel P, Schrciber AD. Pregnancy associated thrombocytopenia : Pathogenesis and Management. Blood 1992, 80: 2697-714.
25. Cook RL, Millor RC, Katz VL. Immune thrombocytopenic purpura in pregnancy and reappraisal of management. Obstet Gynaecol 1991, 78: 578-583.
26. Andrew M, Castle V, Saijals et al. Clinical impact of neonatal thrombocytopenia. S Pediatr 1987, 110: 457-64.
27. Goldman M, Filion M, Proulx C et al. Neonatal alloimmune thrombocytopenia. Med Rev 1994, 8: 123-131.
28. McKenzies S, Kim HC. Neonatal autoimmune and alloimmune thrombocytopenia. J Pediatr Hematol Oncol 1994, 1: 167-174.
29. Bussel JB, Zabusky M, Berkowitz et al. Foetal alloimmune thrombocytopenia. N Engl J Med 1997, 337: 22.
30. Deaver JE, Leppert PC, Zaroulis C. Neonatal alloimmune thrombocytopenic purpura. Am J Perinatol 1986, 3: 127-131.
31. DeVries LA, Connel J, Bydders GM et al. Recurrent intracranial hemorrhage in utero in an infant with alloimmune thrombocytopenia - case report. Br J Obstet Gynaecol 1988, 95: 289.
32. Kaplan C, Daffos F, Forestier G et al. Management of alloimmune thrombocytopenia - antenatal diagnosis and in utero transfusion of maternal platelets. Blood 1988, 72: 340.
33. Daffos F, Forestier F, Muller JY et al. Prenatal treatment of alloimmune thrombocytopenia. Lancet 1984, 2: 632.
34. Editorial - Management of alloimmune neonatal thrombocytopenia. Lancet 1989, 1: 137.
35. Derycke M, Dreyfus M, Ropert JC et al. Intravenous immunoglobulin for neonatal isoimmune thrombocytopenia. Arch Dis Child 1985, 60: 667-669.
36. Anteby E, Shalev O. Clinical relevance of gestational thrombocytopenia < 100,000/ul. Am J Hematol 1994, 47: 118.
37. Blanchette V, Andrew M, Perima M et al. Neonatal autoimmune thrombocytopenia. Role of high dose intravenous immunoglobulin therapy. Blood 1989, 59: 139-144.
38. Menell JS et al. Antenatal management of thrombocytopenia.. Clin Perinatol 1994, 21: 591.
39. Andrew M et al. Randomized controlled trial of platelet transfusion in thrombocytopenic premature infants. Pediatr 1993, 123: 181.
40. George D, Bussel J. Neonatal thrombocytopenia. Semin Thromb Hemost 1995, 21: 278.
41. Tchernia G, Morel-Kopp MC, Yuart J et al. Neonatal thrombocytopenia and hidden maternal autoimmunity. Br J Hematol 1993, 84: 457.
42. Al Mofada SM, Osman ME, Kides E at al. Risk of thrombocytopenia in the infants of the mother with idiopathic thrombocytopenia. Am J Perinatol 1994, 11: 423.
43. Burrows RF, Kelton JG. Low platelet risk in pregnancies associated with idiopathic thrombocytopenic purpura. Am J Obstet Gynaecol 1990, 163: 1147.
44. Sainio J, Joutsi L, Jerreenapa AL et al. Thrombocytopenic purpura in pregnancy. Acta Obstet Gynaecol Scand 1998, 77: 272.
45. Sharon R, Tatarsky T. Low foetal morbidity in pregnancy associated with acute and chronic idiopathic thrombocytopenic purpura. Am J Hematol 1994, 46: 87.
46. Christians GCML, Nieuwenhuiss HK, Von Dens AEGK. Idiopathic thrombocytopenic purpura in pregnancy - a randomized trial on effect of antenatal low dose corticosteroids on neonatal platelet count. Br J Obstet Gynaecol 1990, 97: 893.
47. Zipursky A, Jabar HD. Hematology of bacterial infection. Clin Hematol 1978, 7: 175.
48. Modenlou HD, Ortiz OB. Thrombocytopenia in neonatal infection. Clin Pediatr 1981, 20: 402.
49. Neame PB, Kelton JG, Walker IR et al. Thrombocytopenia in septicemia. The role of disseminated intravascualr coagulation. Blood 1980, 56: 58.
50. Patrick RH, Lazarchick J. Effects of bacteremia on an automated platelet measurement in neonate. Am J Clin Pathol 1990, 93: 391.
51. Corringer JJ. Thrombocytopenia - a laboratory sign of septicemia in infants and children. J Pediatr 1974, 85: 219.
52. Tate DY, Carlton GJ, Johnson D et al. Immune thrombocytopenia in severe neonatal infection. J Pediatr 1981, 98: 449.
53. Murray NA, Roberts IAg. Circulating megakaryocytes and their progenitor in early thrombocytopenia in preterm neonate. Pediatr Res 1996, 40: 112.
54. Padovani EM, Michielutte F, Dall'Agnole et al. Sepsis caused by candida in neonatal period. Pediatr Med Chir 1997, 19: 83.
55. Melville C, Kempley S, Graham J et al. Early onset of systemic candida in extremely preterm neonate. Eu J Pediatr 1966, 155: 904.
56. Alter BP, Young NS. Bone marrow failure syndrome. In : Nathan DG, Oskin FA (eds). Hematology of Infancy and Childhood. Philadelphia, WB Saunders & Co, 1992, Pp. 278.
57. Jones KL. Smith's recognizable pattern of human malformation. 5th Edn, Philadelphia, WB Saunders & Co. 1997, Pp. 322.
58. Heldberg VA, Lipton JM. Thrombocytopenia with absent radius - A review of 100 cases. Am J Pediatr Hematol Oncol 1988, 10: 51.
59. Dell PC and Sheppard JE. Thrombocytopenia absent radius syndrome - Report of two siblings and review of the hematologics and genetic features. Clin Orthop 1982, 162: 129.
60. Hall JG, Levin J, Khun JP et al. Thrombocytopenia with absent radius. Medicine 1969, 48: 411.
61. Zaveri J, Gale R and Kakker VV. Storage pool disease of platelets in an infant with thrombocytopenic absent radii (TAR) syndrome simulating Fanconi's anemia. Hemostasis 1981, 50: 171.
62. George D, Bussel J. Neonatal thrombocytopenia. Semin Thromb Hemost 1995, 21: 278.
63. Andrew M, kelton J. Neonatal thrombocytopenia. Clin Perinatol 1984, 11: 359.
64. Gounder DS, Pullon HW, Oxford PA et al. Clinical manifestation of thrombocytopenia and absent radii syndrome (TAR). Aust NZ J Med 1989, 19: 479.
65. Armitage JO, Hoak JC, Elliett TE et al. Syndrome of thrombocytopenia and absent radii - qualitatively normal platelets with remission following splenectomy. Scand J Hematol 1978, 20: 25.
66. Day HJ, Holmsen HJ. Platelet adenine nucleotide storage pool deficiency in thrombopoietin absent radii syndrome. JAMA 1972, 221: 1053.
67. Sultan Y, Scrobanaci ML, Render F et al. Abnormal platelet function, population and survival time in a boy with congenital absent radii and thrombocytopenia. Lancet 1972, 2: 653.
68. Ballmair M, Schulze H, Strauss C et al. Thrombopoietin in patients with congenital thrombocytopenia and absent radii - elevated serum levels, normal receptor expression but defective reactivity to thrombopoietin. Blood 1997, 90: 612.
69. Sekine I, Hagiwara T, Miyazaki H et al. Thrombocytopenia with absent radii syndrome studies on serum thrombopoietin level and megakaryocytosis in vitro. J Pediatr Hematol Oncol 1998, 20: 74.
70. Mannen Alderan, John Kelton. Clinics in Perinatology 1984, 2: 35.
71. Gershanik JJ, Morgan SK, Akers R. Fanconi's anemia in a neonate. Acta Pediatr Scan 1972, 61: 63.
72. McIntosh S, Brey WR, Lubiniecki AS. Fanconi's anemia - the pre-anemic phase. Am J Pediatr Hematol Oncol 1979, 1: 107.
73. O'Neill EM, Varadi S. Neonatal aplastic anemia and Fanconi's anemia. Arch Dis Child 1963, 38: 92.
74. Shahdi NT, Gerald PS, Dimond LK. Alkali resistant hemoglobin in aplastic anemia of both acquired and congenital type. N Engl J Med 1962, 266: 117.
75. Swift MR, Hirschhorn K. Fanconi's anemia - inherited susceptibility to chromosome breakages in various tissue. Ann Intern Med 1966, 65: 496.
76. Bloom GE, Warner S, Gerald PS et al. Chormosomal abnormalities in constitutional aplastic anemia. N Engl J Med 1966, 274: 8.
77. Butturini A, Gala RP, Verland PG et al. Hematologic abnormalities in Fanconi's anemia an International Fanconi's Registry study. Blood 1994, 84: 1650.
78. Bloom GE, Warner S, Gerald PS et al. Chromosomal abnormalities in constitutional aplastic anemia. N Engl J Med 1966, 274: 8.
79. Barrett AJ, Brigden WB, Hobbs JR et al. Successful bone marrow transplantation for Fanconi's anemia. Br Med J 1977, I: 420.
80. Muraoka K, Ishii E, Tsuji K et al. Defective response to thrombopoietin and impaired expression of C-mpl MRNA bone marrow cells in congenital amegakaryocytic thrombocytopenia. Br J Hematol 1997, 96: 287.
81. Hohlfeld P, Forestier F, Kaplan C et al. Foetal thrombocytopenia - a retrospective survey of 5194 fetal blood sampling. Blood 194, 84: 1851.
82. Miller M, Cosgrift JM. Hematological abnormalities in newborn infants with Down's sndrome. Am J Med Genet 1983, 16: 173.
83. Hord JD, Gan JC, Whitlock JA. Thrombocytopenia in neonates with trisomy 21. Arch Pediatr Adolesc Med 1995,149: 824.
84. Bader-Meuriser B, Tehernia G, Mielot F et al. Occurrence of myeloproliferative disorder in patients with Noonan syndrome. J Pediatr 1997, 130: 885.
85. Henter JI, Winiaski J, Ljungman P et al. Bone marrow transplantation in the children with congenital amegakaryocytic thrombocytopenia. Bone Marrow Transplant 1995, 15: 799.
86. Wolft JA. Wiskott-Alderich syndrome - clinical immunologic and pathologic observations. J Pediatr 1967, 70: 221-232.
87. Geha RS, Rosen FS, Chatile T. Primary immunodeficiency disease. In : Nathan DG, Oski FA (ed). Hematology of infancy and childhood. Philadelphia, WB Saunders Co, 1992, Pp. 1040.
88. Singer ST, Hurst D-Addiego JE. Bleeding disorder in Noonan syndrome - Three cases reports and review of literature. J Pediatr Hematol Oncol 1997, 19: 130.

Thrombocytopenia in Newborns Thrombocytopenia in Newborns 2015-08-01
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0