Elsevier

Blood Reviews

Volume 16, Issue 1, March 2002, Pages 69-72
Blood Reviews

Regular Article
Alloimmune thrombocytopenia of the fetus and the newborn

https://doi.org/10.1054/blre.2001.0187Get rights and content

Abstract

Fetal/neonatal alloimmune thrombocytopenia results from a maternal alloimmunization against fetal platelet antigens. Care must be taken in making a correct diagnosis that eliminates other causes of thrombocytopenia that may occur during pregnancy. Biological diagnosis is normally made by platelet genotyping and search for the maternal alloantibody using monoclonal antibodies in an antigen capture assay. Fetal alloimmune thrombocytopenia, when severe, may result in intracerebral hemorrhage leading to hydrocephalus and death of the fetus. Neonatal alloimmune thrombocytopenia may be present in an otherwise healthy infant. While screening procedures are not in place to detect fetal/neonatal alloimmune thrombocytopenia, it is true that fetal hydrocephalus, unexplained fetal thrombocytopenia with or without anemia, or recurrent miscarriages should be adequate indicators for suspecting fetomaternal alloimmune thrombocytopenia. Multiparous women with a history of giving birth to at least one alloimmune thrombocytopenic infant should be carefully monitored in subsequent pregnancies. Postnatal management of neonatal alloimmune thrombocytopenia involves compatible platelet transfusion in the neonate. Antenatal management of fetal alloimmune thrombocytopenia is controversial and includes a combination of maternal intravenous gamma globulin (IVIgG) administration, intrauterine platelet transfusions, and corticosteroid therapy, while monitoring fetal platelet counts closely throughout the course of pregnancy. Screening of pregnant women may become a public health issue only after antenatal therapy is more standardized.

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    In these cases ICH tends to occur earlier than in the sibling. An intraparenchymal bleed can occur as early as 16 weeks gestational age because IgG alloantibodies can cross the placenta as early as Week 14 of pregnancy, and fetal GPs are expressed on platelets starting at 16 weeks gestational age.7 For all hemorrhagic complications, including ICH, bleeding and symptoms may be delayed, because the platelet count usually falls further during the first several days of life.

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  • Diagnosis and Management of Neonatal Alloimmune Thrombocytopenia

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    Up to 80% of ICH occur in utero,11,12,14 as early as 16 weeks' gestation,15-17 which may lead to structural and/or metabolic central nervous system abnormalities including hydrocephaly, porencephalic cysts, neuronal migrational disorders, and superficial siderosis.15,18,19 Bleeding at other anatomical sites is unusual.20 A history of NAT in a sibling is the most important predictor of NAT.21

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Correspondence to: Cécile Kaplan, MD, Institut National de Transfusion Sanguine, 6 rue Alexandre Cabanel, 75739 Paris, Cedex 15, France. Tel: 33 1 44 49 30 66; Fax: 01 45 67 19 30. E-mail: [email protected]

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