Foetal and neonatal alloimmune thrombocytopaenia
Open Access
- 10 October 2006
- journal article
- review article
- Published by Springer Science and Business Media LLC in Orphanet Journal of Rare Diseases
- Vol. 1 (1), 39
- https://doi.org/10.1186/1750-1172-1-39
Abstract
Foetal/neonatal alloimmune thrombocytopaenia (NAIT) results from maternal alloimmunisation against foetal platelet antigens inherited from the father and different from those present in the mother, and usually presents as a severe isolated thrombocytopaenia in otherwise healthy newborns. The incidence has been estimated at 1/800 to 1/1 000 live births. NAIT has been considered to be the platelet counterpart of Rh Haemolytic Disease of the Newborn (RHD). Unlike RHD, NAIT can occur during a first pregnancy. The spectrum of the disease may range from sub-clinical moderate thrombocytopaenia to life-threatening bleeding in the neonatal period. Mildly affected infants may be asymptomatic. In those with severe thrombocytopaenia, the most common presentations are petechiae, purpura or cephalohaematoma at birth, associated with major risk of intracranial haemorrhage (up to 20% of reported cases), which leads to death or neurological sequelae. Alloimmune thrombocytopaenia is more often unexpected and is usually diagnosed after birth. Once suspected, the diagnosis is confirmed by demonstration of maternal antiplatelet alloantibodies directed against a paternal antigen inherited by the foetus/neonate. Post-natal management involves transfusion of platelets devoid of this antigen, and should not be delayed by biological confirmation of the diagnosis (once the diagnosis is suspected), especially in case of severe thrombocytopaenia. Prompt diagnosis and treatment are essential to reduce the chances of death and disability due to haemorrhage. Due to the high rate of recurrence and increased severity of the foetal thrombocytopaenia in successive pregnancies, antenatal therapy should be offered. However, management of high-risk pregnancies is still a matter of discussion.Keywords
This publication has 48 references indexed in Scilit:
- Thrombocytopenia in childhoodPublished by Cambridge University Press (CUP) ,2002
- A functional platelet fibrinogen receptor with a deletion in the cysteine-rich repeat region of the β3 integrin: the Oea alloantigen in neonatal alloimmune thrombocytopeniaBlood, 2002
- Neonatal Platelet Counts in Fetal Brain InjuryAmerican Journal of Perinatology, 1999
- Genetic susceptibility and anti-human platelet antigen 5b alloimmunization role of HLA class II and TAP genesHuman Immunology, 1996
- Association of Neonatal Thrombocytopenia and Maternal Anti‐HLA AntibodiesPediatrics International, 1991
- HLA-DRw52a is involved in alloimmunization against PL-A1 antigenHuman Immunology, 1990
- COMPLETE REMISSION OF AUTOIMMUNE THROMBOCYTOPENIA AFTER EXTIRPATION OF A BENIGN ADENOFIBROMA OF THE OVARYBritish Journal of Haematology, 1990
- Intravenous immunoglobulin in treatment of neonatal isoimmune thrombocytopeniaThe Journal of Pediatrics, 1987
- ANTENATAL PLAl TYPING AND DETECTION OF GP IIb‐IIIa COMPLEXBritish Journal of Haematology, 1985
- MATERNAL ANTI-HLA ANTIBODIES AND NEONATAL THROMBOCYTOPENIAThe Lancet, 1981