Thrombocytopenia in Newborns

M R Lokeshwar, Manisha Bavdekar, Shilpa Kulkarni, Nitin Shah
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Treatment of Neonatal Immune Thrombocytopenia
Neonatal alloimmune thrombocytopenia may be associated with fetal thrombocytopenia (as early as 20 weeks of gestation) and neonatal thrombocytopenia. The most serious complication of this hyper-thrombocytopenia is intracranial hemorrhage, which occurs in 10-20% of neonates, and half of these occurs in utero, increasing likelihood of similar complications in subsequent pregnancies (31).

Fetal scalp platelet count during the labor, fetal blood sampling during antenatal period helps in deciding the type of delivery to be conducted. If fetal blood platelet count > 50,000/uL vaginal delivery may be allowed. However, if these criteria are not met, a cesarean section is usually recommended (32,33,34,35,38).

No treatment is required for the mildly affected neonates. However, those with count < 30,000 u/L should receive washed maternal platelets. If the birth of such an infant is anticipated maternal platelet pheresis should be done in advance so as to have non-immunized platelet available for transfusion. Administration of random donor platelets is not effective as 98% of population have PLA1 antigen and hence these platelets are susceptible to antibody mediated destruction.

Intravenous immunoglobulin have been used successfully when antigen negative platelets are not available. Steroids and exchange transfusion have found to be not much of clinical benefit in the management of NAIT. Intravenous immunoglobulin 500-1000 mg/kg/day for 2 days have been used successfully, when antigen negative platelets are not readily available. Platelet count in the neonate may remain low, till the maternally derived antibody is completely cleared, which may even take 4-8 weeks. Steroids in dose 1-2 mg/kg/day can be given to those neonates who continue to have low platelet count or bleeding (32,34,35,37,38).


References
Thrombocytopenia in Newborns Thrombocytopenia in Newborns 02/13/2001
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