Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

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'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Aug 22, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Wiedmeier SE, Henry E, Sola-Visner MC, Christensen RD. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. J Perinatol 2009; 29:130.
  2. Sola-Visner M, Saxonhouse MA, Brown RE. Neonatal thrombocytopenia: what we do and don't know. Early Hum Dev 2008; 84:499.
  3. Chakravorty S, Roberts I. How I manage neonatal thrombocytopenia. Br J Haematol 2012; 156:155.
  4. Kamphuis MM, Paridaans NP, Porcelijn L, et al. Incidence and consequences of neonatal alloimmune thrombocytopenia: a systematic review. Pediatrics 2014; 133:715.
  5. Christensen RD, Carroll PD, Josephson CD. Evidence-based advances in transfusion practice in neonatal intensive care units. Neonatology 2014; 106:245.
  6. Sparger K, Deschmann E, Sola-Visner M. Platelet Transfusions in the Neonatal Intensive Care Unit. Clin Perinatol 2015; 42:613.
  7. Andrew M, Vegh P, Caco C, et al. A randomized, controlled trial of platelet transfusions in thrombocytopenic premature infants. J Pediatr 1993; 123:285.
  8. Kenton AB, Hegemier S, Smith EO, et al. Platelet transfusions in infants with necrotizing enterocolitis do not lower mortality but may increase morbidity. J Perinatol 2005; 25:173.
  9. Bonifacio L, Petrova A, Nanjundaswamy S, Mehta R. Thrombocytopenia related neonatal outcome in preterms. Indian J Pediatr 2007; 74:269.
  10. Curley A, Venkatesh V, Stanworth S, et al. Platelets for neonatal transfusion - study 2: a randomised controlled trial to compare two different platelet count thresholds for prophylactic platelet transfusion to preterm neonates. Neonatology 2014; 106:102.
  11. Murray NA, Howarth LJ, McCloy MP, et al. Platelet transfusion in the management of severe thrombocytopenia in neonatal intensive care unit patients. Transfus Med 2002; 12:35.
  12. Josephson CD, Su LL, Christensen RD, et al. Platelet transfusion practices among neonatologists in the United States and Canada: results of a survey. Pediatrics 2009; 123:278.
  13. Cremer M, Sola-Visner M, Roll S, et al. Platelet transfusions in neonates: practices in the United States vary significantly from those in Austria, Germany, and Switzerland. Transfusion 2011; 51:2634.
  14. Stanworth SJ. Thrombocytopenia, bleeding, and use of platelet transfusions in sick neonates. Hematology Am Soc Hematol Educ Program 2012; 2012:512.
  15. Josephson CD, Caliendo AM, Easley KA, et al. Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants: a prospective cohort study. JAMA Pediatr 2014; 168:1054.
  16. Honohan A, van't Ende E, Hulzebos C, et al. Posttransfusion platelet increments after different platelet products in neonates: a retrospective cohort study. Transfusion 2013; 53:3100.
  17. Kiefel V, Bassler D, Kroll H, et al. Antigen-positive platelet transfusion in neonatal alloimmune thrombocytopenia (NAIT). Blood 2006; 107:3761.
  18. Dannaway DC, Noori S. A randomized trial of platelet transfusions over 30 vs 120 minutes: is there an effect on post-transfusion platelet counts? J Perinatol 2013; 33:703.
  19. Stanworth SJ, Clarke P, Watts T, et al. Prospective, observational study of outcomes in neonates with severe thrombocytopenia. Pediatrics 2009; 124:e826.
  20. Baer VL, Lambert DK, Henry E, Christensen RD. Severe Thrombocytopenia in the NICU. Pediatrics 2009; 124:e1095.
  21. Sparger KA, Assmann SF, Granger S, et al. Platelet Transfusion Practices Among Very-Low-Birth-Weight Infants. JAMA Pediatr 2016; 170:687.