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

Received: 21 July 2025     Accepted: 6 August 2025     Published: 28 August 2025
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Abstract

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.

Published in International Journal of Medical Case Reports (Volume 4, Issue 3)
DOI 10.11648/j.ijmcr.20250403.14
Page(s) 55-58
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Neonate, ITP, Thrombocytopenia, Neonatal Autoimmune Thrombocytopenia, Splenectomy

1. Introduction
Multiple studies have established the normal platelet number ranges between 150,000/µL and 450,000/µL. Neonates with a platelet count below 150,000/µL are considered thrombocytopenic. Of all live births 1-5% have thrombocytopenia, 0.1-0.5% being severe thrombocytopenic (platelet count < 50,000/µL). Neonates who are admitted to NICU have a higher chance of being thrombocytopenic, 22 - 35% of admitted cases. Preeclampsia, sepsis, prolonged rupture of membrane, prematurity, perinatal asphyxia and necrotizing enterocolitis are some of the risk factors associated with neonatal thrombocytopenia.
In some newborns, a low platelet count can be caused by the mother’s immune system. This happens when certain antibodies from the mother cross the placenta and attack the baby’s platelets. There are two main types of this condition. One is called neonatal alloimmune thrombocytopenia, which occurs when the mother’s immune system reacts to the baby’s platelets as if they were foreign. The other is neonatal autoimmune thrombocytopenia, which usually affects babies born to mothers with immune conditions like immune thrombocytopenia (ITP) or lupus. While autoimmune thrombocytopenia tends to be less severe, both types can still cause serious problems — including Intracranial hemorrhage (ICH).
Maternal platelet count does not reliably predict neonatal platelet count, but screening is recommended in cases of maternal thrombocytopenia, especially with autoimmune causes or a history of splenectomy. Severe neonatal thrombocytopenia, even in the absence of symptoms, requires prompt recognition and treatment to avoid serious outcomes.
Here, we present the case of a term male neonate born to a 25-year-old mother with chronic ITP and prior splenectomy, who developed severe thrombocytopenia and was successfully treated with intravenous immunoglobulin (IVIG).
2. Case Presentation
A male neonate born from 25 years old para 2 mothers at 39+6 weeks via spontaneous vaginal delivery. The mother has been a chronic ITP patient for 14 years. She has been treated with prednisolone which increases the platelet count for a while. Despite the treatment she experienced multiple severe thrombocytopenias requiring hospital admission and platelet transfusion. For steroid-refractory thrombocytopenia she underwent a splenectomy 11 years ago. Despite the splenectomy her platelet count was between 30,000/µL and 40,000/µL for a long time, requiring transfusions in multiple visits. She has delivered a healthy male neonate at term four years ago without maternal and neonatal complications; the child is alive, healthy and has developed appropriate for his age.
She has regular antenatal care without requiring platelet transfusion. Workups for HIV, VDRL and Hepatitis-B-viruses were negative. Obstetric ultrasound was appropriate for the gestational age. There were no maternal comorbidities, like hypertension or diabetes mellitus. During pregnancy she took two doses of tetanus toxoid vaccine and iron supplementation.
Labor started spontaneously at 39+6 weeks and lasted 11 hours with intrapartum rupture of membrane 30 minutes before delivery. A 3.2 kg male neonate born with APGAR score of 8 and 9 at first and fifth minute, respectively. Considering the maternal history the baby was taken to NICU, despite being clinically stable and has no petechiae, bruising or rash.
The first platelet count being 18,000/µL, serial CBC was done with nadir being 8,000/µL on the third day. The neonate was treated with intravenous immunoglobulin (IVIG) at 1 g/kg/day for 5 consecutive days: without platelet transfusion. The platelet count reached 132,000/µL when discharged on the 10th day. Transfontanelle ultrasound was done which shows no abnormality (i.e Intracranial hemorrhage). Then the neonate has follow-up at a high risk pediatric clinic; on the fourth month platelet count was 348,000/µL and development is appropriate for age. The serial CBC results are presented in the following table.
Table 1. Serial CBC value of the neonate.

DATE

Day 1

Day 3

Day 6

Day 7

Day 10

4 months

WBC (µL)

16100

13800

18500

13800

13500

7700

Neutrophil (%)

80.3

60.5

69.5

44.4

46.4

23.9

Lymphocyte (%)

11

18.4

10.3

29.3

25.5

60

HCT (%)

58.4

63.9

54

59

49.5

34.4

HGB (g/dL)

19.3

20.6

18.7

19.3

16.4

12.3

MCV (fL)

111.8

114

106.2

111

108.2

106.3

MCH (pg)

36.9

37

36.2

36.3

35.9

27.4

PLATLET (×10³/µL)

18

8

11

43

132

348

MPV (fL)

10.2

8

9.6

12.6

11.3

10.1

3. Discussion
Neonatal thrombocytopenia occurs in 1-5% of all newborns at birth and 22-35% in NICU admitted neonates. Among these 8% of preterm and 6% of NICU admissions developed severe thrombocytopenia Although 4-12% of pregnancies are complicated with maternal thrombocytopenia, there’s weak correlation with neonatal thrombocytopenia. However, Neonates born to mothers with ITP or SLE have a 10% chance of developing neonatal autoimmune thrombocytopenia .
Neonatal autoimmune thrombocytopenia occurs due to transplacental passage of maternal antiplatelet antibodies to the fetus. This can result in decreased platelet count within the first few days of life, the nadir mostly being between 2nd and 5th day . In contrast, there’s another immune mediated thrombocytopenia called neonatal alloimmune thrombocytopenia (NAIT). NAIT occurs when maternal antibodies that react against alloantigens are found on the surface of fetal platelets. Unlike neonatal autoimmune thrombocytopenia, NAIT has higher risk of clinical complications .
Neonatal autoimmune thrombocytopenia is usually clinically asymptomatic. proactive screening in neonate for thrombocytopenia and intracranial hemorrhage (despite being in < 1% of cases) should be done to diagnose neonatal autoimmune thrombocytopenia. Having previous delivery complicated by neonatal autoimmune thrombocytopenia is a strong predictor in occurrence of neonatal autoimmune thrombocytopenia .
In the management of pregnancies complicated by maternal ITP, invasive procedures to take blood samples from the fetus should be avoided. After delivery cord platelet count should be determined as soon as possible. For those with platelet count < 100,000 /µL serial CBC should be done until stabilization. In addition to serial CBC, cranial ultrasound is recommended to assess intracranial hemorrhage when platelet count is < 50,000/µL. If ICH is found, MRI can be used for confirmation or clarification. In case of ICH steroids and IVIG is used to maintain the platelet count at optimal level. Neonates with symptomatic bleeding or platelet count < 30,000/µL should be treated with IVIG alone .
This case illustrates an example of early diagnosis and management of classic cases of neonatal autoimmune thrombocytopenia. Although the older brother has no history of neonatal thrombocytopenia, given the maternal history of chronic ITP and splenectomy history, screening has led to early diagnosis and management according to updated recommendations. Our patient had both serial CBC and cranial ultrasound investigations done, since the platelet count has been <30,000/µL on first evaluation. The favorable outcome in our patient can be attributed to the proactive neonatal evaluation and multidisciplinary approach to minimize the complications and ensure optimal outcome.
4. Conclusion
Severe neonatal autoimmune thrombocytopenia is a very rare clinical presentation, especially when prior delivery was uncomplicated. Despite most cases being asymptomatic with mild to moderate thrombocytopenia, early screening of neonates after delivery is crucial to optimal outcome. In our case, despite the presence of a healthy older sibling, the maternal history of chronic ITP and prior splenectomy significantly increased the neonate’s risk. Therefore, immediate postnatal evaluation, including CBC, after delivery should be a custom in mothers with a history of chronic ITP or SLE. Such evaluations should be aimed at noticing complications and initiating treatment as early as possible.
Abbreviations

APGAR

Activity, Pulse, Grimace, Appearance, Respiration

HIV

Human Immunodeficiency Virus

ITP

Immune Thrombocytopenia

IVIG

Intravenous Immunoglobulins

NAIT

Neonatal Alloimmune Thrombocytopenia

NICU

Neonatal Intensive Care Unit

SLE

Systemic Lupus Erythematosus

VDRL

Venereal Disease Research Laboratory

Acknowledgments
We thank Dr Asteway Mulat Haile, Dr. Telila Kumneger, Dr. Tinsae Yidnekachew, Dr. Wasihun Tegete, Dr. Getinet Birhanu, and Dr. Hailemichael Abat for their valuable contributions to this case report and Parents of the patient for giving us written consent to publish this paper.
Author Contributions
Ageru Zeleke Endalew: Conceptualization, Data curation, Formal Analysis, Supervision, Validation, Writing – original draft, Writing – review & editing
Gashaw Arega Mekonnen: Data curation, Supervision, Validation, Writing – original draft, Writing – review & editing
Andebet Sisay Deress: Conceptualization, Data curation, Supervision, Validation, Writing – original draft
Eden Haile Hagos: Conceptualization, Data curation, Resources, Writing – original draft
Elezer Berhanu Zewde: Visualization, Writing – original draft, Writing – review & editing
Rediet Getu Kebede: Visualization, Writing – original draft, Writing – review & editing
Gebeyaw Addis Bezie: Data curation, Visualization, Writing – original draft, Writing – review & editing
Habtamu Ferede Kidanu: Conceptualization, Validation, Writing – original draft
Ethics Approval and Consent to Publication
Informed consent for publication of this case report was obtained from parents of the patient prior to submission.
Funding
There is no funding to report.
Availability of Data and Materials
Not Applicable.
Conflicts of Interest
The authors declare no conflicts of interest.
References
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[3] Mazahir R, Kumari N, Alam S, Singh R. Severe autoimmune thrombocytopenia in a neonate secondary to maternal immune thrombocytopenia: a case report. Int J Sci Rep. 2022; 8(8): 240.
[4] Cines DB, Blanchette VS. Immune Thrombocytopenic Purpura. Published online 2002.
[5] Kiliçdağ H, Gülcan H. NEONATALAUTOIMMUNE THROMBOCYTOPENIA DUE TO MATERNAL IMMUNE THROMBOCYTOPENIC PURPURA: REPORT OF THREE CASES. Turk J Pediatr Dis. 2012; 6(4).
[6] Thakur Y, Meshram RJ, Taksande A. Diagnosis and Management of Immune Thrombocytopenia in Paediatrics: A Comprehensive Review. Cureus. Published online September 18, 2024.
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[9] Melekoğlu NA, Bay A, Aktekin EH, Yilmaz M, Sivasli E. Neonatal Outcomes of Pregnancy with Immune Thrombocytopenia. Indian J Hematol Blood Transfus. 2017; 33(2): 211-215.
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[15] Resch E, Hinkas O, Urlesberger B, Resch B. Neonatal thrombocytopenia—causes and outcomes following platelet transfusions. Eur J Pediatr. 2018; 177(7): 1045-1052.
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Cite This Article
  • APA Style

    Endalew, A. Z., Mekonnen, G. A., Deress, A. S., Hagos, E. H., Zewde, E. B., et al. (2025). Severe Neonatal Autoimmune Thrombocytopenia in a Mother with Chronic ITP After Splenectomy: Treated Successfully with IVIG, Case Report. International Journal of Medical Case Reports, 4(3), 55-58. https://doi.org/10.11648/j.ijmcr.20250403.14

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    ACS Style

    Endalew, A. Z.; Mekonnen, G. A.; Deress, A. S.; Hagos, E. H.; Zewde, E. B., et al. Severe Neonatal Autoimmune Thrombocytopenia in a Mother with Chronic ITP After Splenectomy: Treated Successfully with IVIG, Case Report. Int. J. Med. Case Rep. 2025, 4(3), 55-58. doi: 10.11648/j.ijmcr.20250403.14

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    AMA Style

    Endalew AZ, Mekonnen GA, Deress AS, Hagos EH, Zewde EB, et al. Severe Neonatal Autoimmune Thrombocytopenia in a Mother with Chronic ITP After Splenectomy: Treated Successfully with IVIG, Case Report. Int J Med Case Rep. 2025;4(3):55-58. doi: 10.11648/j.ijmcr.20250403.14

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  • @article{10.11648/j.ijmcr.20250403.14,
      author = {Ageru Zeleke Endalew and Gashaw Arega Mekonnen and Andebet Sisay Deress and Eden Haile Hagos and Elezer Berhanu Zewde and Rediet Getu Kebede and Gebeyaw Addis Bezie and Habtamu Ferede Kidanu},
      title = {Severe Neonatal Autoimmune Thrombocytopenia in a Mother with Chronic ITP After Splenectomy: Treated Successfully with IVIG, Case Report
    },
      journal = {International Journal of Medical Case Reports},
      volume = {4},
      number = {3},
      pages = {55-58},
      doi = {10.11648/j.ijmcr.20250403.14},
      url = {https://doi.org/10.11648/j.ijmcr.20250403.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20250403.14},
      abstract = {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.
    },
     year = {2025}
    }
    

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    AU  - Andebet Sisay Deress
    AU  - Eden Haile Hagos
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    JO  - International Journal of Medical Case Reports
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