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Case Reports
, 44 (7), e175-80

Neonatal Thrombocytopenia: Etiology and Diagnosis

Case Reports

Neonatal Thrombocytopenia: Etiology and Diagnosis

Laura Sillers et al. Pediatr Ann.

Abstract

Neonatal thrombocytopenia has a broad range of possible etiologies. In this review, an asymptomatic newborn infant was found to have severe thrombocytopenia on laboratory testing for limited sepsis evaluation. The differential diagnosis for thrombocytopenia in the newborn period is discussed, along with recommendations for initial evaluation and follow up of isolated thrombocytopenia in an otherwise well-appearing infant. The clinician should be aware of findings associated with unusual causes of thrombocytopenia that should prompt additional evaluation in the nursery or in the general pediatrician's office. In this illustrative case, a high index of suspicion allowed early diagnosis of Wiskott-Aldrich syndrome and prompt curative therapy by stem cell transplant.

Figures

Figure 1
Figure 1
Approach to the well-appearing newborn with platelets <150,000/mcL. CBC, complete blood count; CMV, cytomegalovirus; ICH, intracranial hemorrhage; IVIG, intravenous immunoglobulin; NAIT, neonatal alloimmune thrombocytopenia; PCR, polymerase chain reaction. * There are currently differing opinions on when exactly is the correct time to transfuse without bleeding, but many centers follow these guidelines. If available, washed maternal platelets are preferred due to high suspicion of NAIT in an otherwise well-appearing term infant with severe thrombocytopenia. Random donor platelets can be used if washed maternal platelets are unavailable. If diagnosis of NAIT is not established, some institutions will transfuse random donor platelets initially to look for a subsequent sustained increase in platelet counts, which suggests against NAIT.
Figure 2
Figure 2
(A) Peripheral blood smear (Wright-Giemsa, 1000x): platelets with normal size, shape, and granularity in an unrelated normal patient provided for comparison. (B) Peripheral blood smear (Wright-Giemsa, 1000x). Some of the patient’s platelets showed normal size and granularity (left side). However, a significant subset of the platelets were small and hypogranular (arrows).

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