Chakravorty S., Roberts I.
Copyright © 2014 S. Karger AG, Basel. Thrombocytopenia is the commonest haematological abnormality in neonates where the advice of a haematologist is sought and specialist management may be necessary to prevent associated mortality or long-term disability. The majority of neonates who present with thrombocytopenia within 72 h of birth are preterm and born to mothers with placental dysfunction where chronic fetal hypoxia perturbs normal platelet production. In such cases, thrombocytopenia is usually mild to moderate (platelets 50-150 × 109/l) and resolves within 10 days of birth. Neonatal thrombocytopenia presenting after 72 h of age is usually due to late-onset sepsis or necrotising enterocolitis and is frequently severe and treated with multiple platelet transfusions. In term neonates, where thrombocytopenia is much less common, the clinically most important cause is neonatal alloimmune thrombocytopenia (NAIT). Around 10% of children with NAIT develop intracranial haemorrhage, which may occur prior to birth. Prompt diagnosis and transfusion of HPA-compatible platelets is key to successful management of NAIT. Recent studies indicate that many neonates with severe thrombocytopenia receive platelet transfusions based on consensus national or local guidelines despite little evidence of benefit. Controlled trials of platelet transfusion for neonatal thrombocytopenia, currently in progress, are needed to improve the management of this common complication of neonatal medicine.