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

Arch Argent Pediatr. 2021 Jun;119(3):e202-e214. doi: 10.5546/aap.2021.eng.e202.
[Article in English, Spanish]

Abstract

Thrombocytopenia, defined as a platelet count below 100 x 109/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.

La trombocitopenia, definida como recuento plaquetario inferior a 100 x 109/l, es un hallazgo muy frecuente en el período neonatal, que ocurre, en especial, en niños críticamente enfermos y en prematuros. Sus causas son múltiples: puede deberse tanto a enfermedades del niño como a otros factores involucrados en la interrelación niño-placenta-madre. En este primer artículo, se enumeran las causas de trombocitopenia; se plantea el enfoque diagnóstico frente a un neonato trombocitopénico y se describen detalladamente las distintas entidades correspondientes a trombocitopenias de etiología inmune. Se presentan los diferentes mecanismos causales y se revisan las distintas características de la trombocitopenia secundaria a trombocitopenia inmune materna y de la trombocitopenia neonatal aloinmune. Se describen las diversas estrategias terapéuticas disponibles para cada una de ellas, tanto para su manejo posnatal como para el prenatal. Se enfatiza sobre la gravedad de la enfermedad y las serias complicaciones y secuelas asociadas a la trombocitopenia neonatal aloinmune.

Keywords: immune thrombocytopenia; neonatal alloimmune thrombocytopenia; neonatal thrombocytopenia; platelet transfusion; thrombocytopenic purpura.

Publication types

  • Review

MeSH terms

  • Diagnosis, Differential
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Placenta
  • Platelet Count
  • Pregnancy
  • Purpura, Thrombocytopenic, Idiopathic* / diagnosis
  • Thrombocytopenia, Neonatal Alloimmune* / diagnosis
  • Thrombocytopenia, Neonatal Alloimmune* / etiology
  • Thrombocytopenia, Neonatal Alloimmune* / therapy