CNS Lesions in Neonatal Isoimmune Thrombocytopenia

Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?

“…Our search revealed 24 publications [10,12–14,32–34,37–53], describing 27 mothers, 62 pregnancies and 64 children (two of which were twin pregnancies; refs 38, 45), which fulfilled the inclusion criteria. Twenty of these were case reports, one was a prospective observational study [44] and three were retrospective reviews of records [14,34,51].…”

“…In addition, seven IUFD (41% in total), considered as potentially severe FNAIT cases in this study, were born to primiparous mothers [12,34,38,44,47,49,51]. Eight women had a history of IUFD and had delivered a child with FNAIT and ICH in a preceding pregnancy [12,34,38,39,44,47,49,51]. In one, IUFD preceded a child with thrombocytopenia without ICH, but the third offspring suffered from ICH [51].…”

Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?

“…Our search revealed 24 publications [10,12–14,32–34,37–53], describing 27 mothers, 62 pregnancies and 64 children (two of which were twin pregnancies; refs 38, 45), which fulfilled the inclusion criteria. Twenty of these were case reports, one was a prospective observational study [44] and three were retrospective reviews of records [14,34,51].…”

“…In addition, seven IUFD (41% in total), considered as potentially severe FNAIT cases in this study, were born to primiparous mothers [12,34,38,44,47,49,51]. Eight women had a history of IUFD and had delivered a child with FNAIT and ICH in a preceding pregnancy [12,34,38,39,44,47,49,51]. In one, IUFD preceded a child with thrombocytopenia without ICH, but the third offspring suffered from ICH [51].…”

Cerebellar Loss and Brain-Stem Atrophy Associated with Neonatal Alloimmune Thrombocytopenia in a Discordant Twin

“…Approximately 15% to 20% of infants with NAIT develop ICH during antenatal or perinatal periods [5], with as many as 50% of ICHs occurring antenatally [6]. To date, intracranial abnormalities associated with NAIT have primarily been detected and described by antenatal and postnatal radiographic findings [4,7,8]. These CNS abnormalities include intraventricular and intraparenchymal hemorrhage, porencephalic cysts, ventriculomegaly, and neuronal migrational disorders [7][8][9].…”

“…Intracranial hemorrhage is one of the most feared complications because of the poor neurological outcomes and mortality rate of approximately 15% associated with ICH [4,5]. Approximately 15% to 20% of infants with NAIT develop ICH during antenatal or perinatal periods [5], with as many as 50% of ICHs occurring antenatally [6].…”

“…Although the exact mechanism(s) leading to the CNS lesions associated with NAIT have not been clearly defined, it is likely that a combination of multiple factors, including thrombocytopenia, intrauterine trauma, and/or vascular injury, are responsible [4,9]. In the present case, there was evidence of acute germinal matrix hemorrhage as well as subependymal rosettes with periventricular hemosiderin suggestive of remote and/or chronic irritation of the ventricles, as could be seen with intraventricular hemorrhage(s).…”

Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?

“…Our search revealed 24 publications [10,12–14,32–34,37–53], describing 27 mothers, 62 pregnancies and 64 children (two of which were twin pregnancies; refs 38, 45), which fulfilled the inclusion criteria. Twenty of these were case reports, one was a prospective observational study [44] and three were retrospective reviews of records [14,34,51].…”

“…In addition, seven IUFD (41% in total), considered as potentially severe FNAIT cases in this study, were born to primiparous mothers [12,34,38,44,47,49,51]. Eight women had a history of IUFD and had delivered a child with FNAIT and ICH in a preceding pregnancy [12,34,38,39,44,47,49,51]. In one, IUFD preceded a child with thrombocytopenia without ICH, but the third offspring suffered from ICH [51].…”

Cerebellar Loss and Brain-Stem Atrophy Associated with Neonatal Alloimmune Thrombocytopenia in a Discordant Twin

“…Approximately 15% to 20% of infants with NAIT develop ICH during antenatal or perinatal periods [5], with as many as 50% of ICHs occurring antenatally [6]. To date, intracranial abnormalities associated with NAIT have primarily been detected and described by antenatal and postnatal radiographic findings [4,7,8]. These CNS abnormalities include intraventricular and intraparenchymal hemorrhage, porencephalic cysts, ventriculomegaly, and neuronal migrational disorders [7][8][9].…”

“…Intracranial hemorrhage is one of the most feared complications because of the poor neurological outcomes and mortality rate of approximately 15% associated with ICH [4,5]. Approximately 15% to 20% of infants with NAIT develop ICH during antenatal or perinatal periods [5], with as many as 50% of ICHs occurring antenatally [6].…”

“…Although the exact mechanism(s) leading to the CNS lesions associated with NAIT have not been clearly defined, it is likely that a combination of multiple factors, including thrombocytopenia, intrauterine trauma, and/or vascular injury, are responsible [4,9]. In the present case, there was evidence of acute germinal matrix hemorrhage as well as subependymal rosettes with periventricular hemosiderin suggestive of remote and/or chronic irritation of the ventricles, as could be seen with intraventricular hemorrhage(s).…”

Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?

“…Our search revealed 24 publications [10,12–14,32–34,37–53], describing 27 mothers, 62 pregnancies and 64 children (two of which were twin pregnancies; refs 38, 45), which fulfilled the inclusion criteria. Twenty of these were case reports, one was a prospective observational study [44] and three were retrospective reviews of records [14,34,51].…”

“…In addition, seven IUFD (41% in total), considered as potentially severe FNAIT cases in this study, were born to primiparous mothers [12,34,38,44,47,49,51]. Eight women had a history of IUFD and had delivered a child with FNAIT and ICH in a preceding pregnancy [12,34,38,39,44,47,49,51]. In one, IUFD preceded a child with thrombocytopenia without ICH, but the third offspring suffered from ICH [51].…”

Cerebellar Loss and Brain-Stem Atrophy Associated with Neonatal Alloimmune Thrombocytopenia in a Discordant Twin

“…Approximately 15% to 20% of infants with NAIT develop ICH during antenatal or perinatal periods [5], with as many as 50% of ICHs occurring antenatally [6]. To date, intracranial abnormalities associated with NAIT have primarily been detected and described by antenatal and postnatal radiographic findings [4,7,8]. These CNS abnormalities include intraventricular and intraparenchymal hemorrhage, porencephalic cysts, ventriculomegaly, and neuronal migrational disorders [7][8][9].…”

“…Intracranial hemorrhage is one of the most feared complications because of the poor neurological outcomes and mortality rate of approximately 15% associated with ICH [4,5]. Approximately 15% to 20% of infants with NAIT develop ICH during antenatal or perinatal periods [5], with as many as 50% of ICHs occurring antenatally [6].…”

“…Although the exact mechanism(s) leading to the CNS lesions associated with NAIT have not been clearly defined, it is likely that a combination of multiple factors, including thrombocytopenia, intrauterine trauma, and/or vascular injury, are responsible [4,9]. In the present case, there was evidence of acute germinal matrix hemorrhage as well as subependymal rosettes with periventricular hemosiderin suggestive of remote and/or chronic irritation of the ventricles, as could be seen with intraventricular hemorrhage(s).…”