Photo Quiz

Petechiae in a Newborn


Am Fam Physician. 2015 Dec 1;92(11):1017-1018.

A 29-year-old woman delivered at 39 weeks' gestation by elective repeat cesarean delivery. After this delivery, she was gravida 3, para 2, aborta 1. There was a nuchal cord during delivery, but the newborn had Apgar scores of 8 and 9. The pregnancy was complicated by the mother's obesity and rubella nonimmune status. Her blood type was O Rh-positive.

Findings on the initial newborn examination were normal, with a weight of 3,745 g (8 lb, 4 oz) and normal vital signs. However, at five hours of life, scattered petechiae had developed over his trunk and extremities (Figure 1). A complete blood count showed a normal white blood cell count and hemoglobin level. The platelet count was abnormal at 14 × 103 per μL (14 × 109 per L). His blood type was O Rh-positive, and results of a direct antiglobulin test (Coombs test) were negative. His blood glucose level was normal. Maternal testing for anti-human platelet antigen 1a antibodies was positive with a normal platelet count.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Immune thrombocytopenic purpura.

B. Kasabach-Merritt syndrome.

C. Neonatal alloimmune thrombocytopenia.

D. Perinatal infection.

E. RhD alloimmunization.


Address correspondence to Richard Temple, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

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7. van den Akker ES, de Haan TR, Lopriore E, et al. Severe fetal thrombocytopenia in Rhesus D alloimmunized pregnancies. Am J Obstet Gynecol. 2008;199(4):387.e1–e4.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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