Subscribe to RSS
DOI: 10.1055/s-2001-15254
Alloimmune Thrombocytopenia in the Fetus and Newborn
Publication History
Publication Date:
31 December 2001 (online)
![](https://www.thieme-connect.de/media/sth/200103/lookinside/thumbnails/10.1055-s-2001-15254-1.jpg)
ABSTRACT
Alloimmune thrombocytopenia is an interesting and challenging disease. Identification in the fetus and newborn by screening remains to be clarified. The primary clinical criterion for neonatal diagnosis appears to be a neonatal platelet count of <50 × 10 9 /L. Treatment of the neonate can be accomplished with intravenous immunoglobulin (IVIG) ± steroids or with matched platelet transfusion. Cranial ultrasonography is important. Testing can be performed on the parents and requires a highly experienced laboratory. If an affected fetus is identified, based on a previous affected neonate and a homozygous father, antenatal management is needed. Studies have been completed that inform the still controversial decision. IVIG remains the basis of therapy but appears to require a higher dose (2 g/kg/week) and/or the addition of 1 mg/kg of prednisone in the highest risk cases, those with antenatal intracranial hemorrhage.
KEYWORD
Alloimmune thrombocytopenia - platelets - fetal hematology - intravenous gamma globulin - neonatal thrombocytopenia
REFERENCES
- 1 Bussel J B, Zabusky M R, Berkowitz R L, McFarland J G. Fetal alloimmune thrombocytopenia. N Engl J Med. 1997; 337 22-26
- 2 Williamson L M, Hackett G, Rennie J. The natural history of fetomaternal alloimmunization to the platelet-specific antigen HPA-1a (PlA1, Zwa) as determined by antenatal screening. Blood . 1998; 92 2280-2287
- 3 Kaplan C, Morel-Kopp M C, Kroll H. HPA-5b (Br(a)) neonatal alloimmune thrombocytopenia: clinical and immunological analysis of 39 cases. Br J Haematol . 1991; 78 425-429
- 4 Bussel J B, Berkowitz R L, McFarland J G, Lynch L, Chitkara U. Antenatal treatment of neonatal alloimmune thrombocytopenia. N Engl J Med . 1988; 319 1374-1378
- 5 Paidas M J, Berkowitz R L, Lynch L. Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis. Am J Obstet Gynecol . 1995; 172 475-479
- 6 Bussel J B, Skupski D W, MacFarland J G. Fetal alloimmune thrombocytopenia: consensus and controversy. J Matern Fetal Med . 1996; 5 281-292
- 7 Karpatkin M, Flug F, Karpatkin S. Should all pregnant women be tested for their platelet PLA (Zw, HPA-1) phenotype?. Br J Haematol . 1994; 86 1-5
- 8 Dreyfus M, Kaplan C, Verdy E. Frequency of immune thrombocytopenia in newborns: a prospective study. Immune Thrombocytopenia Working Group. Blood . 1997; 89 4402-4406
- 9 Sainio S, Jarvenpaa A L, Renlund M. Thrombocytopenia in term infants: a population-based study. Obstet Gynecol . 2000; 95 441-446
- 10 de Moorloose P, Boehlen F, Extermann P, Hohfeld P. Neonatal thrombocytopenia: incidence and characterization of maternal antiplatelet antibodies by MAIPA assay. Br J Haematol . 1998; 100 735-740
- 11 Durand-Zaleski I, Schlegel N, Blum-Boisgard C. Screening primiparous women and newborns for fetal/neonatal alloimmune thrombocytopenia: a prospective comparison of effectiveness and costs. Immune Thrombocytopenia Working Group. Am J Perinatol . 1996; 13 423-431
- 12 Bussel J B, Tanli S, Peterson H C. Favorable neurological outcome in 7 cases in perinatal intracranial hemorrhage due to immune thrombocytopenia. Am J Pediatr Hematol Oncol . 1991; 13 156-159
- 13 Friedman J M, Aster R H. Neonatal alloimmune thrombocytopenic purpura and congenital porencephaly in two siblings associated with a ``new'' maternal antiplatelet antibody. Blood . 1985; 65 1412-1415
- 14 Glade-Bender J, McFarland J G, Kaplan C, Porcelijn L, Bussel J B. Anti-HPA-3A induces severe neonatal alloimmune thrombocytopenia: summary of 30 cases. J Pediatr (in press).
- 15 Gururangan S, McFarland J B, Douglas C B, Skupski D, Bussel J B. Bra(HPA-5b) incompatibility causes thrombocytopenia in neonates of mothers with immune thrombocytopenic purpura. Am J Pediatr Hematol Oncol . 1998; 20 202-206
- 16 McFarland J G, Aster R H, Bussel J B. Prenatal diagnosis of neonatal alloimmune thrombocytopenia using allele-specific oligonucleotide probes. Blood . 1991; 78 2276-2282
- 17 Bussel J B, Kaplan C, McFarland J G, and the Working Party on Neonatal Immune Thrombocytopenia of the Neonatal Hemostasis Subcommittee of the Scientific and Standardization Committee of the ISTH. Recommendations for the evaluation and treatment of neonatal autoimmune and alloimmune thrombocytopenia. Thromb Haemost . 1991; 65 631-634
- 18 Herman J H, Jumbelic M I, Ancona R J, Kickler T S. In utero cerebral hemorrhage in alloimmune thrombocytopenia. Am J Pediatr Hematol Oncol . 1986; 8 312-317
- 19 Kaplan C, Daffos F, Forestier F. Management of allo-immune thrombocytopenia: antenatal diagnosis and in utero transfusion of maternal platelets. Blood . 1988; 82 340-346
- 20 Lynch L, Bussel J B, McFarland J G, Chitkara U, Berkowitz R L. Antenatal treatment of alloimmune thrombocytopenia. Obstet Gynecol . 1992; 80 67-71
- 21 Bussel J B, Berkowitz R L, Lynch L. Antenatal management of alloimmune thrombocytopenia with intravenous gammaglobulin: a randomized trial of the addition of low dose steroids to IVIG in fifty-five maternal-fetal pairs. Am J Obstet Gynecol . 1996; 174 1414-1423
- 22 Daffos R, Forestier F, Kaplan C. Prenatal treatment of fetal alloimmune thrombocytopenia. Lancet . 1988; 2 910
- 23 Kroll H, Kiefel V, Giers G. Maternal intravenous immunoglobulin treatment does not prevent intracranial hemorrhage in fetal alloimmune thrombocytopenia. Transfus Med . 1994; 1 290-296
- 24 Doughty H A, Murphy M F, Metcalfe P, Waters A H. Antenatal screening for fetal alloimmune thrombocytopenia: the results of a pilot study. Br J Haematol . 1995; 90 321-324