Severe Neonatal Autoimmune Thrombocytopenia in a Mother with Chronic ITP After Splenectomy: Treated Successfully with IVIG, Case Report

Neonatal autoimmune thrombocytopenia occurs due to the transplacental passage of maternal antiplatelet antibodies and is seen in approximately 10% of neonates born to mothers with immune thrombocytopenia (ITP) or systemic lupus erythematosus (SLE). Although most cases of neonatal autoimmune thrombocytopenia are asymptomatic in rare instances, neonates might develop severe thrombocytopenia that can lead to life threatening bleeding, including Intracranial hemorrhage. Considering those potential consequences, early platelet number determination and other necessary investigations will be beneficial for better outcomes. Intravenous immunoglobulin is the first line of treatment, with most neonates responding to it without requiring transfusions. We report a case of neonatal autoimmune thrombocytopenia in a term male neonate born to a 25 year old woman with chronic ITP. The mother had a splenectomy for refractory thrombocytopenia despite steroid treatment. The neonate was asymptomatic but had thrombocytopenia with a nadir platelet count of 8,000/µL in routine evaluation prompted by maternal ITP history. He was treated with Intravenous Immunoglobulin at 1 g/kg/day for 5 days, without requiring platelet transfusion or experiencing any clinical complication. In subsequent post treatment followups (fourth month) the platelet count increased gradually, reaching 348,000/µL in the fourth month. This case highlights the importance of early detection and treatment of neonatal autoimmune thrombocytopenia, even in the absence of clinical symptoms.