Neonatal thrombocytopenia: a common clinical problem

Abstract

The aim of this study was to review current knowledge about neonatal thrombocytopenia. Neonatal thrombocytopenia is a common hematological problem in preterm and sick newborns. The causes of thrombocytopenia are numerous, and the evaluation and the management of the affected neonates may be challenging. The severity of clinical manifestation varies, depending on the platelet count, underlying disease, and bleeding manifestations. The two main underlying pathophysiological mechanisms are increased platelet destruction and decreased platelet production. In many sick neonates, both accelerated platelet destruction and reduced megakaryocytopoiesis may be present simultaneously. Based on the time of onset, neonatal thrombocytopenia can be divided into early, occurring within the first 72 hours, and late, occurring more than 72 hours after birth. This classification is also useful in the diagnostic evaluation. In the majority of cases, thrombocytopenia resolves within a week without intervention. Severe thrombocytopenia is more common in infants admitted to neonatal intensive care units. It may be associated with major bleeding and requires careful management. Platelet transfusions are the mainstay of the treatment, but there are no universally accepted transfusion guidelines in newborns.

Conclusion – It is important to identify infants at risk, and if needed, initiate transfusion therapy to prevent severe bleeding and potentially significant morbidity. This review summarizes the current understanding of underlying pathophysiologic mechanisms and management of neonatal thrombocytopenia.