Thrombocytopenia in Newborns

M R Lokeshwar, Manisha Bavdekar, Shilpa Kulkarni, Nitin Shah
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Clinical Features Suggestive of Immune Thrombocytopenia In Thrombocytopenic Neonates
Clinical manifestations reflect the severity of thrombocytopenia. Infants may be born with severe, generalised petechiae, rash or purpura or may appear normal at birth and may develop symptoms and signs of thrombocytopenia any time during 2-3 day post-partum and are rarely associated with other disorders or factors that accounts for thrombocytopenia. Usually they are otherwise healthy infants born to healthy mother with normal platelet count and neonates often associated with thrombocytopenia < 50,000/u/L.

Most severe complication is intracranial hemorrhage which is seen in approximately 10-15% cases and half of these occurs in utero as early as 20 weeks of pregnancies (31) and majority of them have neuro-developmental sequele and hence USG skull should be performed to all neonates with Feto-Maternal Neonatal Allo-Immune Thrombocytopenia (FMNAIT) before discharge (31-33).

Confirmation of diagnosis ideally requires demonstration of maternal and fetal platelet incompatibility and absence of antigen in mother's serum, which is present in the child. When tested against panel of platelets of known antigenicity, specific antigen involved (usually PLA1) can be demonstrated to be lacking on the mother's platelet but is present in newborn's and father's platelets. However, laboratory facilities may not be available in the majority of centers (32,33).


References
Thrombocytopenia in Newborns Thrombocytopenia in Newborns 2/13/2001
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