Thrombocytopenia in newborns – What could be the cause?
Basically one has to distinguish between congenital and acquired thrombocytopenia in the newborn. Thrombocytopenia occurs before birth or from the first days of life (congenital) or during the first weeks or months of life (acquired). Most thrombocytopenia in humans is acquired as a result of infections or as a side effect of medication.
Idiopathic immunothrombocytopenic purpura (ITP) is an important form of thrombocytopenia. A synonym for ITP is Werlhof’s disease. In this clinical picture, there is typically an isolated drop in the number of thrombocytes (affecting only the thrombocytes) in childhood with numbers below 100.
000/ul. The cause of ITP is still unknown, although previous viral infections of the upper respiratory tract are assumed. Werlhof’s disease is the most common cause of bleeding tendencies in children.
Diagnostically, two possible manifestations provide evidence for ITP. On the one hand, IgG antibodies can be detected in the blood plasma, which are directed against the thrombocytes and are often formed in the unenlarged spleen. In addition, isolated thrombocytopenia is conspicuous by its shortened lifespan with reactively increased megakaryopoiesis in the bone marrow puncture.
As congenital forms of thrombocytopenia, various diseases are possible causes. Usually, however, these are very rare and are subdivided into the presence of reduced platelet formation or the formation of defective platelets, which are subsequently broken down prematurely. Congenital amegakaryocytic thrombocytopenia (CAMT) should be mentioned here.
This shows a reduced formation of the precursor cells of the thrombocytes, the megakaryocytes in the bone marrow. The problem here is an aggravating formation disturbance of other blood cell lines. A bone marrow transplantation should be considered as a form of therapy.
In addition, Wiskott-Aldrich Syndrome (WAS) is another disease of the congenital thrombocytopenia group. This syndrome is associated with an immune deficiency. For this reason, the patients affected suffer from a tendency to bleed and a possible increased susceptibility to infection.
Eczema (inflammation of the skin with itching and formation of papules and reddening of the skin) and inflammatory bowel diseases are also common. Almost exclusively male individuals are affected, since the WAS is inherited x-chromosomally. In Bernard-Soulier-Syndrome (BSS), pathologically enlarged platelets are conspicuous, which are subject to a severe functional defect and are therefore sorted out. In addition, among congenital thrombocytopenia, X-linked macrothrombocytopenia with disturbance of the formation of platelets and erythrocytes (red blood cells) and MYH9-associated diseases with complex defects in the MYH9 gene should be mentioned.
