Clinical features

• Petechiae indicate problems with small vessels or platelets, bruises can be due to platelet deficiencies and/or coagulation disorders.

• Oozing from multiple venepunture sites in sick infants usually indicates generalised haemostatic failure and DIC.

• Haemorrhagic disease of the newborn due to functional vitamin K deficiency presents in 3 forms with bruising, purpura and GI bleeding in otherwise well babies; early (within 24h) usually due to maternal drugs such as warfarin, classical (days 2-5) in babies who have not been given adequate vitamin K prophylaxis and who have been breast fed and late, a variant of the classical form (i.e. insufficient vitamin K, breast-fed) arising at 2-8 weeks and with a higher morbidity and t incidence of ICH.

• Thrombosis usually catheter related, can be rarely associated with AT III deficiency or homozygous protein C and protein S deficiency (neonatal purpura fulminans—a life-threatening condition with widespread peripheral gangrene).

• Haemophilia and other coagulant deficiencies can cause large haematomas but rarely cause trouble in the neonatal period except factor XIII lack—typically presents with bleeding from the umbilical stump.

• In well babies, petechiae and bruises with thrombocytopenia suggests immune basis—antibody usually from mother (alloimmune or autoimmune). Rarely, infants under a month can develop endogenous ITP.

• Clear symptoms of thrombocytopenia with normal platelet count suggests major functional defect—Glanzmann's.

• Marrow failure due to infiltration, aplasia.

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