What are the International Consensus Report recommendations for treatment of neonates born to women with immune thrombocytopenia (ITP)?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Recommendations for the management of neonates born to women with ITP include the following [40] :

  • Obtain umbilical cord platelet count at the time of delivery or as soon as possible.
  • Repeat the platelet count as needed depending on platelet levels, trends in the count, and response to treatment (if any). If cord platelet count is < 100 × 10 9/L, repeat the platelet count daily until stable. The incidence of pseudothrombocytopenia is high in neonates because of the difficulties encountered in obtaining unclotted blood with blood draws.
  • If platelet count is < 50 × 10 9/L at birth, perform a cranial ultrasound. A magnetic resonance imaging for confirmation or clarification can be performed without anesthesia using the sleep and swaddle approach 30 to 60 minutes prior.
  • In the case of ICH, give IVIG and limited steroids to maintain platelet count >100 × 10 9/L for 1 week if possible and >50 × 10 9/L for another week. The use of platelet transfusion may increase neonatal risk.
  • If there is symptomatic bleeding or if platelet count is < 30 × 10 9/L, with or without platelet transfusion, give IVIG.
  • If severe thrombocytopenia continues for >1 week in a breast-fed infant, consider pausing breastfeeding for a few days to see whether platelet count increases.
  • Women who had a splenectomy may have a thrombocytopenic newborn, even if their platelet count is normal.
  • The only currently reliable predictor of whether a baby will be thrombocytopenic is if a previous sibling was thrombocytopenic.

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