Abstract

Neonatal alloimmune thrombocytopenia (NAIT) is caused by maternal alloantibodies directed against fetal paternally derived platelet-specific antigens destroying fetal platelets. We present a patient (HPA-1a negative platelets with genotype 1b/1b) with NAIT complicated by significant obstetric and psychiatric history.

A 32-year-old woman with a history of alcoholism and self-harm presented with her 10^th pregnancy (Gravida 10 Para 6+3 miscarriages. Her 1^st three children were with a partner with genotype 1a/ib heterogeneity. Her third baby was delivered spontaneously at 36 weeks but had NAIT and was transfused with immunoglobulin/platelets. Her next baby had intrauterine platelet transfusion and was delivered by caesarean section (CS) at 34 weeks, as platelets were 10x109/L.

Her subsequent full-term pregnancy with another partner was uncomplicated. The next pregnancy with a new partner (genotype 1a/1a homogenous) was a vaginal delivery at 36 weeks but the baby had NAIT and required platelets/immunoglobin transfusions.

The initial management plans for her current pregnancy included weekly immunoglobulin infusions under the supervision of a local obstetrician and haematologist with fetal intracranial scans at the regional fetal medicine centre. Due to her psychiatric and social circumstances, her care was conducted locally. At 36 weeks, she had a breech presentation. Concerns regarding external cephalic version and preterm labour resulted in an elective CS performed at 36 weeks.

Intensive antenatal surveillance and good patient compliance is vital but this patient's care had to be tailored to accommodate her social and psychiatric problems. This resulted in her baby not sustaining any neurological deficits and not requiring transfusions.