Neonatal thrombocytopenia: Causes, Symptoms & Treatments
Causes
The definition of neonatal thrombocytopenia is defined as 150,000 / μL or less, and 1 to 2% may occur in normal children, but most of them have few symptoms and severely decrease to less than 50,000 in some cases. Most causes are classified according to the timing of platelet reduction. Placental dysfunction (preeclampsia, intrauterine growth retardation, etc.) and perinatal history of early onset occurring within 72 hours of birth. It may be considered a perinatal infection (eg E. coli, GBS, Haemophilus infuenzae), DIC, homologous immunity, autoimmune, congenital infection, thrombosis, metabolic disease, hereditary congenital disease and Kasabach-Merritt syndrome. Late onset after 72 hours of birth may be caused by delayed onset sepsis, neonatal necrotizing enteritis, congenital infection, metabolic disease, autoimmune, hereditary congenital disease.
Immune thrombocytopenia is largely autoimmune and allogeneic. Autoimmunity is the case when an anti-platelet antibody is made in the maternal body and is delivered through the placenta, which has antibodies in 2 out of 1000 women, of which about 10% lead to a decrease in neonatal platelets. In addition, 1% of these can cause serious bleeding complications. Clinical features usually decrease platelets 3 to 4 days after birth and increase again from 7 days. If the mother has an autoimmune thrombocytopenia, the neonate should monitor the platelet count within 24 hours and monitor it during treatment.
Symptoms
Homozygous immune thrombocytopenia is the father's genetic cause of maternal platelet antibody is produced and when the mother is sensitized, it produces IgG antibody to attack placenta platelets across the placenta. One out of every 1,500 people develops severe platelet loss from the first pregnancy and is further exacerbated by repeated pregnancies. The clinical course has a wide range of mild cases of recovery within weeks, and severe cases of death or neuropathy. Mothers with normal platelet counts are suspected of severe reduction in neonates and are diagnosed by detecting paternal antibodies in the maternal blood.
In the process of differential diagnosis, a physical examination is performed to determine whether the baby is seriously ill or not, and the maternal history and obstetrics are examined. If the baby is sick, prolongation to confirm PT, aPTT prolongation should be differentiated from DIC, sepsis, acidemia, hypoxia, cold, severe liver disease, uninjured infection, visceral hyperactivity, bone marrow infiltration, necrotizing enteritis . If the baby is not sick, the mother's platelet count is normal. If maternal platelets are decreased, maternal ITP, maternal drug use, familial thrombocytopenia, normal immune thrombocytopenia, neonatal drug use, hemangioma, Consider the mothers ITP that have been resolved.
Treatments
IV immunoglobulin can be used for both autoimmune and allogeneic immune thrombocytopenia. Indications were platelet counts of less than 30,000 and 18,000 in this group, and 1 g / kg IVIG was administered on November 1 and November 4. In case of suspected homologous immunity, IVIG 1 g / kg / day is used for 2 days. In severe reduction, platelet transfusion is necessary. The indications are summarized as follows.
- below 30,000 / μL: all transfusion
- 30,000 to 49,000 / μL: 1) body weight <1500 g or less than 7 days after birth 2) Clinically unstable
3) Blood clotting disorder 4) Significant bleeding history
5) before surgery 5) within 72 hours immediately after surgery
- 50,000 to 100,000 / μL: 1) active hemorrhage, 2) allogeneic immunity with intracranial hemorrhage, 3) preoperative and postoperative neurosurgery
The definition of neonatal thrombocytopenia is defined as 150,000 / μL or less, and 1 to 2% may occur in normal children, but most of them have few symptoms and severely decrease to less than 50,000 in some cases. Most causes are classified according to the timing of platelet reduction. Placental dysfunction (preeclampsia, intrauterine growth retardation, etc.) and perinatal history of early onset occurring within 72 hours of birth. It may be considered a perinatal infection (eg E. coli, GBS, Haemophilus infuenzae), DIC, homologous immunity, autoimmune, congenital infection, thrombosis, metabolic disease, hereditary congenital disease and Kasabach-Merritt syndrome. Late onset after 72 hours of birth may be caused by delayed onset sepsis, neonatal necrotizing enteritis, congenital infection, metabolic disease, autoimmune, hereditary congenital disease.
Immune thrombocytopenia is largely autoimmune and allogeneic. Autoimmunity is the case when an anti-platelet antibody is made in the maternal body and is delivered through the placenta, which has antibodies in 2 out of 1000 women, of which about 10% lead to a decrease in neonatal platelets. In addition, 1% of these can cause serious bleeding complications. Clinical features usually decrease platelets 3 to 4 days after birth and increase again from 7 days. If the mother has an autoimmune thrombocytopenia, the neonate should monitor the platelet count within 24 hours and monitor it during treatment.
Symptoms
Homozygous immune thrombocytopenia is the father's genetic cause of maternal platelet antibody is produced and when the mother is sensitized, it produces IgG antibody to attack placenta platelets across the placenta. One out of every 1,500 people develops severe platelet loss from the first pregnancy and is further exacerbated by repeated pregnancies. The clinical course has a wide range of mild cases of recovery within weeks, and severe cases of death or neuropathy. Mothers with normal platelet counts are suspected of severe reduction in neonates and are diagnosed by detecting paternal antibodies in the maternal blood.
In the process of differential diagnosis, a physical examination is performed to determine whether the baby is seriously ill or not, and the maternal history and obstetrics are examined. If the baby is sick, prolongation to confirm PT, aPTT prolongation should be differentiated from DIC, sepsis, acidemia, hypoxia, cold, severe liver disease, uninjured infection, visceral hyperactivity, bone marrow infiltration, necrotizing enteritis . If the baby is not sick, the mother's platelet count is normal. If maternal platelets are decreased, maternal ITP, maternal drug use, familial thrombocytopenia, normal immune thrombocytopenia, neonatal drug use, hemangioma, Consider the mothers ITP that have been resolved.
Treatments
IV immunoglobulin can be used for both autoimmune and allogeneic immune thrombocytopenia. Indications were platelet counts of less than 30,000 and 18,000 in this group, and 1 g / kg IVIG was administered on November 1 and November 4. In case of suspected homologous immunity, IVIG 1 g / kg / day is used for 2 days. In severe reduction, platelet transfusion is necessary. The indications are summarized as follows.
- below 30,000 / μL: all transfusion
- 30,000 to 49,000 / μL: 1) body weight <1500 g or less than 7 days after birth 2) Clinically unstable
3) Blood clotting disorder 4) Significant bleeding history
5) before surgery 5) within 72 hours immediately after surgery
- 50,000 to 100,000 / μL: 1) active hemorrhage, 2) allogeneic immunity with intracranial hemorrhage, 3) preoperative and postoperative neurosurgery
