Neonatal Thrombocytopenia: Causes, Symptoms And Treatment

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Neonatal thrombocytopenia is a condition where a neonate has an abnormally low number of thrombocytes or platelets. Platelets are blood cells produced in the bone marrow and support blood clotting. Thus, if a baby has thrombocytopenia, they could develop bleeding problems. It is a common clinical problem in infancy.

Typically, a platelet count of 150,000 to 450,000 per microliter is desirable for newborns. Hence, if a neonate has a platelet count of less than 150,000 per microliter, they are said to have thrombocytopenia, even though this platelet count isn’t low enough to cause apparent problems. Some newborns, especially preterm ones, may have a low platelet count in the first few days of life. However, it increases eventually in most cases.

Read on to learn more about the causes, risk factors, signs, treatment, and complications of thrombocytopenia in babies.

Classification Of Thrombocytopenia

Neonatal thrombocytopenia can be classified based on the underlying cause, condition, or other factors leading to it. The following are some of the common types of thrombocytopenia (1).

  • Immune thrombocytopenia (ITP)
  • Thrombocytopenia due to infections, such as bacterial,viral, or fungal infections
  • Drug-induced thrombocytopenia (DITP)
  • Genetic and congenital anomalies-related thrombocytopenia
  • Thrombocytopenia due to increased consumption of thrombocytes, a result of conditions such as hypersplenism and necrotizing enterocolitis
  • Thrombocytopenia due to miscellaneous causes
  • Idiopathic thrombocytopenia where there is no known cause

Causes Of Thrombocytopenia In The Newborn

Inadequate production and early breakdown of platelets are the primary causes of thrombocytopenia in babies. The following conditions during fetal life or after birth can cause platelet dysfunctions in infants (2).

  • Preeclampsia (high maternal blood pressure)
  • Genetic disorders
  • Metabolic disorders
  • Exposure to certain drugs, such as aspirin and indomethacin, during fetal life or after birth
  • Bone marrow infections in the fetal stage
  • Infections, such as rubella and syphilis
  • Maternal antibodies against fetal platelets causing an early breakdown of the newborn’s platelets
  • Perinatal asphyxia (oxygen deprivation during birth)
  • Intrauterine growth restrictions

Illnesses in babies may trigger the early breakdown of platelets. In some babies, the cause of low platelet counts is not known, and it is called idiopathic thrombocytopenia.

Risk Factors For Thrombocytopenia In Babies

The following factors may increase the risk for thrombocytopenia in babies (1).

  • Premature birth
  • Very low birth weight
  • Prolonged stay in a neonatal intensive care unit (NICU)
  • Phototherapy
  • History of placental insufficiency

Thrombocytopenia in ill babies, premature babies, and babies admitted in NICU may indicate underlying pathological processes. Platelet count in the fetus increases with gestational age. Since premature babies are born early, they are likely to have lower platelet counts for a few weeks.

Signs And Symptoms Of Thrombocytopenia

The common signs and symptoms of thrombocytopenia in newborns include the following (2).

  • Petechiae, small red spots on the skin
  • Bruises on skin
  • Purpura or skin hemorrhages that also appear as red spots
  • Bleeding from various parts of the body, including nose bleeding, gum bleeding, and intestinal bleeding
  • Jaundice may occur due to bruising, and the baby develops yellow skin and eye color
  • Intracranial hemorrhage

Clinical features may vary depending on the severity of thrombocytopenia. Some babies could be born with these symptoms, while a few may develop them within days after birth. You may seek medical care for an exact diagnosis since these signs and symptoms are also seen in other conditions.

Diagnosis Of Thrombocytopenia

Physical examination and the symptoms can be suggestive of thrombocytopenia. Blood tests are ordered to determine the platelet counts (3). Thrombocytopenia is often detected during routine blood examination in asymptomatic babies.

Additional tests, such as kidney function, liver function, erythrocyte sedimentation (ESR) rate, vitamin B12 and folic acid levels, and bone marrow aspiration, could be conducted to diagnose thrombocytopenia or exclude the possibility of other illnesses. Imaging tests are often required to look for intracranial hemorrhages.

Treatment For Thrombocytopenia In Babies

The treatment options may vary depending on the underlying cause. Babies with mild thrombocytopenia and who show no clinical signs and symptoms require no treatment. Platelet transfusion is necessary for babies with too few platelet counts and clinical manifestations (4).

Babies with maternal antibodies against platelets receive low doses of steroids. It may take four to eight weeks to completely clear maternal antibodies from the infant’s blood.

If there is a known risk of thrombocytopenia before birth, the baby could require transfusion of maternal platelets after birth. If maternal platelets are not available, the donor platelets are used. The donor platelets are transfused with intravenous immunoglobulins to reduce immune-mediated destruction.

The type of delivery is also planned according to the platelet count in the fetal blood. Vaginal delivery is attempted only if the fetal platelet count is more than 50,000 per microliter. Cesarean section is recommended if the platelet count is lower than it.

Possible Complications Of Thrombocytopenia In Newborns

Thrombocytopenia complications are due to bleeding, which occurs due to low platelet count. Bleeding into tissues and skin is common. Bleeding could also increase the breakdown of erythrocytes (red blood cells), leading to excess bilirubin, a by product. It could eventually result in jaundice (5).

Intracranial hemorrhages (bleeding within the skull) can be life-threatening since it increases intracranial pressure and causes oxygen deprivation to tissues. If not resolved on time, severe bleeding could result in cardiovascular dysfunction, shock, and prolonged inadequate oxygen supply to the brain, leading to permanent brain damage.

Frequently Asked Questions

1. Is neonatal thrombocytopenia an emergency?

In most cases, neonatal thrombocytopenia is not an emergency. Mild cases do not require treatment but are kept under observation until the platelet count increases. Moderate to severe fetal thrombocytopenia is rare. Only severe cases require immediate treatment, in the absence of which the condition may lead to morbidity or mortality (6).

2. Can neonatal thrombocytopenia be prevented?

Neonatal thrombocytopenia cannot be prevented. Postnatal complications can be avoided by determining the severity of the condition and treating the baby accordingly. However, fetal thrombocytopenia may recur in subsequent pregnancies. Doctors manage this condition with maternal therapies or in utero transfusions (7).

An abnormally low number of platelets in the blood is termed thrombocytopenia. A baby with thrombocytopenia may experience bleeding, which can be risky. Premature birth, low birth weight, and prolonged stay in the NICU are some factors that may increase an infant’s risk of developing thrombocytopenia. Small red spots on the skin or frequent bleeding, jaundice, and intracranial hemorrhage are some of the main signs and symptoms of thrombocytopenia. Prompt diagnosis and treatment can improve the outcomes, and treatment depends on the underlying causes. However, in most cases, the condition resolves by itself.

Key Pointers

  • Neonatal thrombocytopenia is of various types and occurs due to early breakdown or insufficient production of platelets.
  • Red spots and bruises on the skin, bleeding in multiple body parts, and jaundice are typical signs of this condition.
  • Treatment is suggested by a doctor based on the cause and severity.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. Thrombocytopenia In Newborns;PediatricOncall
2. Thrombocytopenia in the Newborn; Lucile Packard Children’s Hospital Stanford
3. Thrombocytopenia in the Newborn; University of Rochester Medical Center
4. Thrombocytopenia in Neonates; Victorian Agency for Health Information
5. Thrombocytopenia in the Newborn; Nationwide Children’s Hospital
6. Fetal Thrombocytopenia and Its Relation to Maternal Thrombocytopenia; The New England Journal of Medicine
7. C Kaplan; Immune thrombocytopenia in the foetus and the newborn: diagnosis and therapy; (2001); NCBI
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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more

Dr. Tashawna Stokes

(MD)
Dr. TaShawna Stokes is a mom to two beautiful daughters and currently practices in the Atlanta area. She received her undergraduate and medical degrees from Auburn University and The University of South Alabama. She completed her Pediatric Residency at Children’s Hospital of Los Angeles. After completing a chief year, she has worked in urgent care, inpatient and private practice in... more

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