Neonatal Bleeding
History: Bleeding from umbilical stump, circumcision.
Illness during pregnancy, maternal meds, previous OB history, family history
of bleeding disorders.
Examination: Sick or well? Petechiae, bleeding, bruising,
jaundice, retinal findings, organomegaly.
Differential Diagnosis
Factor deficiency
vWD
thrombocytopenia
platelet qualitative disorder
hypofibrinogenemia, dysfibrinogenemia
Lab Studies
CBC with differential
PT, PTT
Factor studies depending on screening results
Bleeding time is difficult to assess in newborns
vWB workup (VIII assay, vWB factor, ristocetin aggregation, consider
multimer analysis)
Treatment
-
Vitamin K 1 mg im/iv, may need to repeat
-
FFP, cryo, platelets, depending on etiology
-
Cryo if decreased factor VIII or fibrinogen
-
Factor concentrate: only if already documented diagnosis for specific factor
deficiency
-
Platelets if thrombocytopenic (<20,000) and bleeding; possibly 50,000
if isoimmune.
-
For auto or iso-immune: IVIG, prednisone, washed maternal platelets or
PLA-1 negative platelets.
-
If any questions about diagnosis, ask coag lab to save sample of plasma
(frozen).
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Last modification: April 15, 2001