A case report of neonatal alloimmune thrombocytopenic purpura: the importance of correct diagnosis for future pregnancies

Abstract

CONTEXT: Neonatal alloimmune thrombocytopenic purpura (NAITP) is a neonatal disorder characterized by maternal alloimmunization against fetal platelet antigens inherited from the father. Intracranial hemorrhage leading to death or permanent neurological disability may occur in the fetus. CASE REPORT: A healthy 30-year-old woman gave birth to her first baby by cesarean after an uneventful 36-week pregnancy. Ten hours after birth, the infant presented severe petechiae, with platelet count of 8 x 10³/µl. The mother’s platelet count was normal (180 x 10³/µl). The infant received intravenous immunoglobulin and was discharged 18 days later, with platelet count of 100 x 10³/µl. The cause of thrombocytopenia was not elucidated at that time. One year later, the infant died of neuroblastoma. Since the parents wanted another child, they were referred for investigation of this thrombocytopenia. Platelet genotyping and platelet antibody screening were performed, showing total HPA-1 system mismatch between mother (HPA-1b1b) and father (HPA-1a1a), with anti-HPA-1a antibodies in the mother’s serum. We concluded that the first baby was born with NAITP. Thus, in the second pregnancy, the mother was treated with several infusions of intravenous immunoglobulin. Careful ultrasound monitoring was performed, with normal results for mother and fetus throughout the pregnancy. The second baby was born by cesarean at 39 weeks, presenting 92x10³ platelets/µl six hours after birth. The baby’s platelets were genotyped as HPA-1a1b and the mother’s serum again showed anti-HPA-1a antibodies. No clinical bleeding was observed. Intravenous immunoglobulin therapy was an effective treatment for preventing NAITP in the second baby.

Clinical and Biological Evolution of the Newborn With Thrombocytopenia in the Neonatal Intensive Care Unit

“…Prevalence of hypoxemia Nadkarniet al (21) 23.9% term hypoxic neonates 33.3% preterm hypoxic neonates Our study 48.5% term hypoxic neonates 51.5% preterm hypoxic neonates Fig. 2 Severity of thrombocytopenia.…”

“…Neonatal thrombocytopenia is usually mild to moderate; with spontaneous resolution and without requiring any specific therapy. The major risk of severe thrombocytopenia is intracranial hemorrhage leading to death or neurological disability [21,22], but no direct relationship between the severity of thrombocytopenia and the severity of intracranial hemorrhage has been observed [22]. The frequency of intracranial hemorrhage was estimated in 1% -3% of cases [23].…”

Severe bleeding complications other than intracranial hemorrhage in neonatal alloimmune thrombocytopenia: a case series and review of the literature

“…Not only will this lead to a quicker diagnosis and targeted treatment, it will also lead to the ability of preventing FNAIT and bleeding complications in a possible subsequent pregnancy. This rationale is underlined by Fontão‐Wendel and colleagues as well as Madani and coworkers . The latter reported a delayed or missed diagnosis in 15% of first affected children, retrospectively, in 26 FNAIT cases that were treated during a subsequent pregnancy.…”

“…The latter reported a delayed or missed diagnosis in 15% of first affected children, retrospectively, in 26 FNAIT cases that were treated during a subsequent pregnancy. Fontão‐Wendel and coworkers described a case of a firstborn with petechiae and a PLT count of 8 × 10 9 /L, discharged without a diagnosis. A year later, preconceptional advice yielded immunohematologic evaluation, which showed a HPA‐1a mismatch between mother and father, leading to adequate monitoring and treatment in the subsequent pregnancy.…”

“…The same trend can be observed in clinical practice, where the occurrence of ICH in an otherwise healthy infant is immediately associated with FNAIT. This is in contrast to other bleeding problems, where the proper diagnosis might be delayed or even missed, denying these women adequate care in future pregnancies . In this study, we evaluated the occurrence of severe hemorrhage other than ICH in neonates with FNAIT, and present a review of the literature.…”