Low platelets in infants can have a variety of causes and multiple effects. The clinical name for low platelets is thrombocytopenia, and indicates a platelet count of less than 150,000 per microliter of blood. Many babies, especially those who are in a neonatal intensive care unit (NICU) can have platelet counts that run low. Thrombocytopenia can lead to bruising; bleeding from sites such as the gums; and petechiae, which is a series of red spots found on the skin that are actually tiny areas of bleeding. Low platelet counts also put a baby at risk of a brain bleed, and a physician should be consulted to determine whether there is a need for treatment.
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Donor Platelet Transfusion
Thrombocytopenia in infants is treated with a transfusion of platelets to reduce the risk of complications. Each physician may have a set of guidelines as to what level they are willing to let platelet counts drop to before transfusing. A transfusion is also dependent on other symptoms, such as excessive bruising or bleeding from various sites. Platelet transfusions can be prepared from donors and should be of a compatible blood type. They should not contain cytomegalovirus and should have a low number of white blood cells.
In some conditions, a baby’s platelets will be incompatible with a mother’s. During the placental exchange of blood that occurs with pregnancy, a mother will produce antibodies against a baby’s platelets. This condition is called neonatal alloimmune thrombocytopenia (NAIT) and can destroy a baby’s platelets, resulting in low counts. Treatment for NAIT is done by giving the baby a transfusion of the mother’s platelets that have been washed. Washing the platelets removes the antibodies and they can then be used to treat the situation.
Treatment with intravenous immune globulin (IVIG) may help platelet counts and can be used in conjunction with a platelet transfusion or alone in the case of NAIT where the mother’s platelets are not available. IVIG is also called immunoglobulin G or IgG, because gamma globulin is an active component of the mixture. Administering IVIG increases the amount of platelets, bringing the count to a safer level and reducing complications.
Approximately 80 percent of babies that have infections also have low platelet counts, particularly with those born preterm or in the NICU. Infection causes a diminished production of platelets and an increase in the destruction of platelets that are present. Use of antibiotics to treat the underlying infection can save some platelets and reduce their overall destruction.
Some drugs can cause a decrease in platelets. Examples of these are indomethacin, which is used to treat a heart murmur; heparin, which prevents clotting and is a common component of syringes used in medication administration; and lipid transfusions, which provide fats to supplement nutrition. Stopping these medications or reducing their use if possible, while also treating low platelet counts, can correct the situation.
REFERENCES & RESOURCES
- University of Michigan Department of Pediatrics: Intravenous Immunoglobulin is Effective Therapy for Idiopathic Thrombocytopenic Purpura
- Neonatal Handbook: Thrombocytopenia
- ResourceNurse.com: Intravenous Immunoglobulin
- “Newborn Intensive Care--What Every Parent Needs to Know”; Jeanette Zaichkin, RNC, MN; 2002
- Merck: Thrombocytopenia