Breast feeding may exacerbate neonatal thrombocytopenia secondary to maternal autoimmune thrombocyptopenic purpura

Newborns with thrombocytopenia born to mothers with idiopathic thrombocytopenic purpura (ITP) are at risk for bleeding such as bruising, petechiae and gastrointestinal or intracranial hemorrhage. The passage of maternal Immunoglobulin G (IgG) antiplatelet antibodies through placenta causes thrombocytopenia in the unborn fetus and the newborn. Human colostrum/milk contains various IgG molecules and thus in mothers with ITP, the transfer of antiplatelet antibodies through breast milk can theoretically prolong and/or exacerbate the thrombocytopenia. In the following case report, above mechanism may explain the drop in the patient's platelet count. A 36 week EGA male was born to a 21 year old primigravida hispanic mother with chronic untreated ITP. Because of severe thrombocytopenia during pregnancy, the mother received glucocorticosteroids starting at 15th week of gestation until delivery. In addition, she received two rounds of IVIG (intravenous immunoglobulins) before a splenectomy on 18th week of gestation followed by an additional four rounds of IVIG before an elective cesarean section at 36th week. Patient was born with platelet count of 52 K/mm³ with no clinical signs of bleeding. Patient was breast fed 30 minutes after birth and repeat count eight hours later revealed platelet count of 30K. Breast feeding was stopped, patient was switched to formula and over next 40 hours platelet counts of 41K, 45K and 55K were obtained. Upon resumption of the breast feeding, platelet count dropped to 28K. Breast Feeding was terminated and a week later, platelet count was 118K. Efforts are underway to phenotype maternal platelet antigen(s) and isolate the platelet specific IgG in the breast milk. This case report suggests cautious approach in recommending breast feeding in mothers with severe ITP in the first four days of life.