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.
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.
REFERENCESshow all references
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3. Blickstein I, Friedman S. Fetal effects of autoimmune disease. In: Fanaroff AA, Martin RJ, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 10th ed. Philadelphia, Pa.: Elsevier; 2015:304–307.
4. Kaplan C. Neonatal alloimmune thrombocytopenia. Haematologica. 2008;93(6):805–807.
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This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.
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