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Clinical manifestations, evaluation, and management of neonatal thrombocytopenia

Caraciolo J Fernandes, MD
Section Editors
Joseph A Garcia-Prats, MD
Donald H Mahoney, Jr, MD
Deputy Editor
Melanie S Kim, MD


Although thrombocytopenia is relatively rare in the general newborn population, it occurs frequently in patients admitted to neonatal intensive care units (NICUs). The major mechanisms are either increased platelet destruction or decreased platelet production. Severe neonatal thrombocytopenia (platelet count <50,000/microL) can be associated with bleeding and, potentially, significant morbidity. As a result, it is important to identify at-risk neonates and, if needed, initiate therapy to prevent associated complications.

The clinical manifestations, evaluation, and management of neonatal thrombocytopenia are reviewed here. The causes of neonatal thrombocytopenia are discussed separately. (See "Causes of neonatal thrombocytopenia".)


Neonates with thrombocytopenia may present as follows:

Neonates are diagnosed incidentally by a low platelet count when a complete blood count (CBC) is obtained for other reasons (eg, sepsis work-up). These patients may be ill-appearing due to the underlying disorder, or asymptomatic.

At-risk infants – Infants with risk factors for thrombocytopenia are often asymptomatic and are detected by a screening CBC. Risk factors include a maternal history of thrombocytopenia due to autoimmune disease (eg, immune thrombocytopenia purpura [ITP] or systemic lupus erythematous [SLE]), previous affected sibling (eg, neonatal alloimmune thrombocytopenia [NAIT]), or specific disorders associated with thrombocytopenia that may be identified by characteristic physical findings. These include thrombocytopenia-absent radius syndrome, congenital infections such as cytomegalovirus (CMV) and rubella, and chromosomal disorders (eg, trisomies 21, 18, and 13). (See "Causes of neonatal thrombocytopenia", section on 'Genetic disorders' and "Causes of neonatal thrombocytopenia", section on 'Infection'.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 20, 2016.
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