Diagnosis and treatment of transient neonatal thrombocytopenia (Draft clinical recommendations for discussion by specialists)

Abstract

Transient neonatal thrombocytopenia occurs with a frequency of 0.7–0.9% and is divided by etiological factor into primary (alloimmune and transimmune) and secondary (symptomatic) thrombocytopenia, according to the time of occurrence of thrombocytopenia is divided into early and late. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome of varying severity, which occurs in 20–30% of newborns with thrombocytopenia, in other newborns thrombocytopenia is asymptomatic. The most severe clinical symptom is intracranial hemorrhages, which occur in 10–30% of cases. The most common types of bleeding of the platelet-vascular type are petechiae, ecchymoses, nosebleeds, melena, hematuria, cephalohematoma and other types of bleeding. In dynamics, symptoms of posthemorrhagic anemia may appear with massive bleeding (pallor, tachycardia, tachypnea, decreased blood pressure). The main criterion for the diagnosis of transient neonatal thrombocytopenia is a decrease in the number of platelets below the reference values for a given gestational and chronological age of a newborn child. To diagnose the type of thrombocytopenia, a thorough collection of maternal anamnesis is necessary, examination of parents if they suspect the immune nature of the disease, diagnosis of the disease as a result of which thrombocytopenia has developed, if it is secondary. Correction of thrombocytopenia, if indicated, is carried out by intravenous administration of platelet concentrate. If the immune nature of thrombocytopenia with severe thrombocytopenia is suspected and/or the presence of moderate and higher hemorrhagic syndrome, the administration of normal human immunoglobulin is recommended. If immunoglobulin therapy for immune thrombocytopenia is ineffective, glucocorticoids are prescribed.