Thrombocytopenia is common in sick preterm babies. Despite this, platelet production in thrombocytopenic preterm babies has rarely been assessed. To address this problem we have developed miniaturized assays to study circulating megakaryocyte (MK) progenitors [burst-forming unit (BFU)-MK and colony-forming unit (CFU)-MK], total cultured MK precursors and mature MK, by culturing mononuclear cells purified from 0.5-1 mL of preterm peripheral blood. MK lineage colonies and cells are identified by an anti-IIb/IIIa antibody (CD61). We prospectively studied circulating BFU-MK/CFU-MK, total cultured MK precursors and mature MK in 63 preterm babies (gestational age 24-34 wk). Twenty-six developed early thrombocytopenia (platelets < 150 x 10(9)/L by 48 h), whereas the remaining 37 babies maintained normal platelet counts. Twenty-one of the 26 thrombocytopenic babies were born to mothers with pregnancy-induced hypertension or were growth retarded. At birth, thrombocytopenic babies had severely reduced numbers of all MK precursors compared with nonthrombocytopenic babies: BFU-MK 82 +/- 50 versus 663 +/- 174 colonies/mL, mean +/- SEM; CFU-MK 596 +/- 196 versus 3267 +/- 530 colonies/mL; total MK precursors 97 +/- 30 versus 301 +/- 49 x 10(3) cells/mL and mature MK 8 +/- 2 versus 37 +/- 8 x 10(3) cells/mL, respectively. Thrombocytopenia resolved by d 10 in all babies accompanied or preceded by a recovery to normal numbers of circulating MK progenitors. Eighteen (69%) of the thrombocytopenic babies were also neutropenic (neutrophils < 2 x 10(9)/L); in these babies neutrophil progenitor cells (CFU-granulocyte/monocyte) were also severely reduced compared with the nonthrombocytopenic babies (539 +/- 280 versus 1937 +/- 348 colonies/mL, mean +/- SEM). This indicates that the principal cause of the thrombocytopenia and neutropenia is reduced platelet and neutrophil production occurring as a consequence of reduced numbers of MK and CFU-granulocyte/monocyte progenitors, respectively. Taken together these data suggest the hematologic abnormalities characteristic of newborns born to mothers with pregnancy-induced hypertension or with intrauterine growth retardation are a consequence of dysregulation of fetal hemopoiesis occurring proximal to committed MK and neutrophil progenitors, most likely at the level of the primitive multipotent hemopoietic stem cell.