What are platelet disorders?
Platelets are pieces of blood cells that form blood clots. They are like “little band-aides” that are necessary to help wounds heal and to prevent bleeding. Fetuses and newborns with platelet disorders may have too few or too many platelets; in other cases, they may have the correct number of platelets, but the platelets do not function as they should.
Fetuses and newborns who have a low number of platelets are at risk for bleeding, as are those whose platelets do not function properly. Bleeding from platelet disorders may cause bleeding within the brain, which can cause damage to the brain tissue. If there are too many platelets, then the fetus or newborn is at risk for blood clots.
There are several types of platelet disorders:
- Thrombocytopenia: any disorder in which there are too few platelets
- Glanzmann’s thrombasthenia: a disease in which the blood lacks a protein that is needed for the blood cells to clot normally
- Bernard-Soulier syndrome: a disease in which platelets are unable to properly stick to the walls of injured blood vessels, so the blood is not able to clot as it should
- Von Willebrand disease: a condition in which the blood cannot clot properly because it does not produce enough of a protein called von Willebrand factor.
How are platelet disorders diagnosed?
Prior to delivery:
Platelet disorders are diagnosed prior to delivery, either by an ultrasound finding suspicious for fetal bleeding such as blood in the brain, or a maternal or family history of low platelets (thrombocytopenia), most commonly due to alloimmune thrombocytopenia (AIT) occurring during a pregnancy, or immune thrombocytopenia purpura (ITP) in the mother. Is important to tell your obstetrician about any personal or family history of a platelet disorder, especially if your sister has had a baby with bleeding or thrombocytopenia. If a platelet disorder is suspected prior to delivery, the cause may be diagnosed by testing the mother and father’s blood.
Some babies with platelet disorders do not have symptoms; others may have any or all of the following symptoms:
- Bleeding gums
- Abnormal bruising
If your doctor suspects your baby may have a platelet disorder, blood tests will be done to confirm the diagnosis. Common blood tests for diagnosing platelet disorders include:
- A complete blood count (CBC) allows the doctor to see how many blood cells your baby has, including the number of platelets.
- Prothrombin time (PT) measures the time it takes for the liquid portion of your baby’s blood to clot.
- Partial thromboplastin time (PTT) measures how long it takes for your baby’s blood to clot.
- A platelet aggregation test measures how well platelets clump together (aggregate) and cause clotting.
- A bleeding time test measures how quickly bleeding stops.
How are platelet disorders treated?
Prior to delivery, platelet disorders may be treated by giving medications such as steroids or intravenous antibodies to the mother. In rare cases the fetus may benefit from an intrauterine transfusion of platelets by cordocentesis
If your baby has low platelets at birth it is very important that you be evaluated by a Maternal-Fetal Medicine specialist prior to getting pregnant again. AIT usually worsens with subsequent pregnancies, and a MFM specialist can provide treatments that are lifesaving. Also if you have a sister(s), she should be notified and tested to see if she is also at risk for having an affected baby.
Platelet disorders are lifelong conditions. There is no cure and no specific treatment. Babies with von Willebrand disease may be given a medication called desmopressin (DDAVP) to raise von Willebrand factor levels and reduce the chances of bleeding.
In certain instances, platelet transfusions may be required to stop or help prevent bleeding.
How will platelet disorders affect my baby during and after surgery?
If your baby is a boy, your doctor may not perform a circumcision after delivery if a platelet disorder is suspected. A circumcision may be performed at a later date if it is determine that your son is not a high risk for bleeding.
Babies with platelet disorders do not require surgery. However, if your child requires surgery for another condition in the future, antifibrinolytic medications may be given before the surgery to slow bleeding and help with clotting.
As your child grows, care should be taken to avoid activities that may cause bleeding (for example, your child should avoid contact sports).
People with platelet disorders should not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. These drugs can prolong bleeding times and prevent platelets from aggregating.
Girls may need hormonal contraceptives to control heavy menstrual bleeding when they reach puberty.