Neonatal thrombocytopenia: A review. I. Definitions, differential diagnosis, causes, immune thrombocytopenia

Abstract

Thrombocytopenia, defined as a platelet count below 100 x 10 9 /L, is a very common finding in the neonatal period, especially in critically ill infants and preterm newborns. Its causes are multiple: it may be due both to pediatric conditions and to other factors involved in the fetal-placental-maternal interface. This initial article describes the causes of thrombocytopenia, proposes a diagnostic approach to manage a thrombocytopenic newborn infant, and provides a detailed description of the different conditions corresponding to thrombocytopenia of immune etiology. It also describes the different causative mechanisms and reviews the varying characteristics of thrombocytopenia secondary to maternal immune thrombocytopenia and neonatal alloimmune thrombocytopenia. The different treatment approaches to each of the different conditions are described both for their pre-as well as their postnatal management. The severity of thrombocytopenia and the serious complications and sequelae associated with the neonatal alloimmune thrombocytopenia are highlighted.

The Prevalence and Associated Risk Factors for Neonatal Thrombocytopenia Among Newborns Admitted to the Neonatal Intensive Care Unit

“…It is further classified according to the time of occurrence, with early-onset thrombocytopenia occurring before 72 hours after birth and late-onset thrombocytopenia occurring beyond 72 hours after birth [4,5]. The causes of NTP can be divided into maternal, perinatal, and neonatal causes according to the timing of the condition's start (early vs. late), gestational age (term vs. preterm), the underlying mechanism (increased destruction (consumption) of platelets, or a mix of both processes), and the general health of the newborn [6,7]. The best way to categorize NTP causes into fetal, early-onset, and late-onset is by when they first manifest.…”

An infant with severe neonatal immune thrombocytopenia and gradual resumption of breastfeeding

“…[1][2][3][4][5] Severe thrombocytopenia, defined as platelet counts of <50 × 10 3 /μL, is less common (∼10%). 2,3,[5][6][7][8] Clinical manifestations of NITP range from asymptomatic to severe bleeding, although intracranial hemorrhage is rare (<1%). 1,2,9 While thrombocytopenia characteristically resolves by 2 months, 2,4,10 persistent thrombocytopenia beyond this timeframe has been observed in breastfed infants.…”

“…2,3,[5][6][7][8] Clinical manifestations of NITP range from asymptomatic to severe bleeding, although intracranial hemorrhage is rare (<1%). 1,2,9 While thrombocytopenia characteristically resolves by 2 months, 2,4,10 persistent thrombocytopenia beyond this timeframe has been observed in breastfed infants. 10,11 Immunoglobulin A (IgA) antiplatelet antibodies, targeting α IIb β 3 integrin, have been detected in breast milk (BrM) of women with ITP, 10 with thrombocytopenia resolution being reported following breastfeeding discontinuation.…”

“…Thrombocytopenia occurs in the first week of life in approximately one in three neonates. [1][2][3][4][5] Severe thrombocytopenia, defined as platelet counts of <50 × 10 3 /μL, is less common (∼10%). 2,3,[5][6][7][8] Clinical manifestations of NITP range from asymptomatic to severe bleeding, although intracranial hemorrhage is rare (<1%).…”

Hematological aberrations in patient with Jacobsen syndrome

“…It is the most frequent bleeding disorder in children. One of its most common forms is immune thrombocytopenia (ITP), with an incidence of 1.9-6.4 per 100,000 births [6]. In the neonatal Acta Haematologica Polonica 2023, vol.…”