A male newborn presented to the emergency department of a rural hospital in South India at 3 days of age with poor feeding, excessive crying, and unsettled behavior. Over the next few days, he developed seizures, followed by increasing hyperpigmentation that is most pronounced over his face and neck.

The infant breastfed well during the first 48 hours but became ill on the third day after birth with poor feeding, excessive crying, and unsettled behavior. He was admitted to the NICU for further evaluation and management.

The infant’s blood test results on day 1 of admission (Table) showed severe thrombocytopenia (12,000/μL [12.0×109/L]), lymphopenia (10.3%), and abnormal coagulation studies (international normalized ratio 7, prothrombin time >300 seconds, and activated partial thromboplastin time >300 seconds).

The infant received platelet and fresh frozen plasma transfusions soon after admission to the NICU in view of the severe thrombocytopenia and coagulopathy,...

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