Intracranial Hemorrhage and Autoimmune Thrombocytopenia in a Neonate: A Rare "Unpredictable" Event

Abstract

Neonatal thrombocytopenia is a rare complication of maternal autoimmune thrombocytopenia, and no maternal predictors of its gravity and potential complications have been identified. Neonatal cerebral hemorrhage, a feared event in the setting of autoimmune thrombocytopenia, is fortunately uncommon, but it can occur in utero or in the perinatal period, with potentially serious consequences. The authors report the case of a boy born to a mother affected by autoimmune thrombocytopenia, who presented with severe thrombocytopenia at birth and developed intracranial hemorrhage despite mild maternal thrombocytopenia at delivery and a prompt preventive treatment of the newborn. Platelet count should be tested at birth in all babies born from mothers with autoimmune thrombocytopenia, irrespective of maternal platelets counts during pregnancy or at delivery, and should be closely monitored during the first days of life. Systematic early and serial cranial ultrasound might be advocated in the setting of neonatal thrombocytopenia.

Keywords: autoimmune; brain; magnetic resonance imaging; neonatal seizures; neonate; neuroimaging; seizures.

Figure 1.

Coronal brain ultrasound shows hyperechoic lesions in the occipital lobes. On the right, the lesion is larger and heterogeneous, with a central hypoechoic zone and a hyperechoic peripheral zone suggesting hemorrhage (white arrowheads).

Figure 2.

Brain MRI: Subpial hemorrhage (white arrows) is depicted as a high-intensity signal on axial T1-weighted sequence (A) and low-intensity signal on coronal T2-weighted sequence (B). On the T2-weighted sequence, the leptomeningeal localization of the bleeding is clearly visible and is associated with high-intensity signal cortical edema (white arrowheads).

Figure 3.

Platelet count trend and timing of treatment. H indicates hours of life; D, days of life; M, month of life; ↑, platelet transfusion; ⇡, immunoglobulin administration.