Fetal and Neonatal Alloimmune Thrombocytopenia: Harvesting the Evidence to Develop a Clinical Approach to Management

Abstract

Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in an otherwise healthy newborn. The most serious complication is intracranial hemorrhage, which can occur either in the fetus or the newborn. Despite the known serious sequelae, both antenatal management and neonatal treatment modalities are plagued by the lack of gold standard evidence to appropriately direct therapy. Maternal, risk-based therapeutic approaches range from invasive protocols to relatively benign noninvasive strategies to avoid serious procedural complications. Intravenous immunoglobulin (IVIG) with or without steroids and fetal blood sampling constitute the mainstay of antenatal management. Neonatal interventions principally focus on the use of antigennegative compatible or random donor platelets and IVIG. While awaiting the results of controlled trials, each institution must develop a standardized, collaborative, multidisciplinary approach to the screening, diagnostic evaluation, and management of unexpected and anticipated NAIT based on experience, product availability, and emerging scientific data.

Low‐dose prednisone and immunoglobulin G treatment for woman at risk for neonatal alloimmune thrombocytopenia and T helper 1 immunity

“…In the case of paternal heterozygosity for the offending antigen or an unidentified father, fetal platelet genotyping can be performed on amniotic cells. 32 However, it requires an invasive method with adverse side-effects. Fetal DNA isolated from maternal plasma can be used for fetal platelet genotyping, which is a safer method.…”

“…In the case of paternal heterozygosity for the offending antigen or an unidentified father, fetal platelet genotyping can be performed on amniotic cells 32. The alloimmunization by HPAs might be caused by very small syncytiotrophoblast micro particles (STMP) released from syncytiotrophoblasts (ST).…”

“…Th1/Th2 immune response during the second trimester of the second pregnancy even with prednisone may be associated with platelet sensitization. It also defenses antigen binding and a variety of effector functions such as complement activation, complement binding, and binding to Fc receptors 32. Prednisone and high-dose IgG treatment suppress the inflammatory and immune-mediated process, increase the effects of T regulatory cells and prevent reticuloendothelial uptake of alloantibody coated platelet, by blocking Fc receptors of macrophages.…”

Preimplantation Genetic Diagnosis for Fetal Neonatal Alloimmune Thrombocytopenia Due to Antihuman Platelet Antigen Maternal Antibodies

“…Its use now is reserved for sampling before platelet intrauterine transfusion or when contemplating vaginal delivery, and it is individualized based on experience and product availability for each institution. 8,9 Because the invasive approach to the antenatal intrauterine therapy is associated with both fetal and maternal complications, investigators have sought various alternatives.…”

Et nyfødt barn med petekkier

“…Det pågår en nasjonal og internasjonal debatt om screening og rutiner for forebygging/behandling (12)(13)(14)(15). Helsedirektoratet satte i 2008 ned en arbeidsgruppe som skulle vurdere screening for føtal/neonatal alloimmun trombocytopeni.…”