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Petechiae in a Newborn

 


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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.

Question

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.

D

Address correspondence to Richard Temple, MD, at richard.w.temple2.mil@mail.mil. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Espinoza JP, Caradeux J, Norwitz ER, Illanes SE. Fetal and neonatal alloimmune thrombocytopenia. Rev Obstet Gynecol. 2013;6(1):e15–e21....

2. Roberts I, Stanworth S, Murray NA. Thrombocytopenia in the neonate. Blood Rev. 2008;22(4):173–186.

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.

5. Symington A, Paes B. Fetal and neonatal alloimmune thrombocytopenia: harvesting the evidence to develop a clinical approach to management. Am J Perinatol. 2011;28(2):137–144.

6. Peterson JA, McFarland JG, Curtis BR, Aster RH. Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management. Br J Haematol. 2013;161(1):3–14.

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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