Frequency of Immune Thrombocytopenia in Newborns: A Prospective Study

Dreyfus, Marie; Kaplan, C.; Verdy, E; Schlegel, Nicole; Durand‐Zaleski, Isabelle; Tchernia, Gil

doi:10.1182/blood.v89.12.4402

Cited by 285 publications

(166 citation statements)

References 20 publications

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“…Our results are dif®cult to compare with those of other authors, who assumed different platelet counts as tpenia, and often included newborns from intensive care units. If, however, we only compare severe cases (<50r10 9 /l), our data (0.15%) are consistent with those reported in other studies: 0.12% (9,14) and 0.14% (11).…”

Section: Discussionsupporting

confidence: 92%

“…In the presence of such factors, the relationship between antiplatelet antibodies and neonatal t-penia sometimes remains uncertain (14). We observed such diseases/factors in t-penic newborns born to mothers with immune t-penia, with non-immune t-penia, with hidden immune t-penia and even in newborns with NAIT, although very rarely in the latter group, just as in other studies (10,11,13,14,22). Our observation that ICH can occur in newborns with a relatively high platelet count and no obvious signs of diathesis, especially in the presence of prematurity and/or infection, deserves further attention.…”

Section: Discussionsupporting

confidence: 79%

“…Other diseases/factors, such as prematurity, fetal distress, or infection, play an important role in neonatal t-penia (11,13,17,22). In the presence of such factors, the relationship between antiplatelet antibodies and neonatal t-penia sometimes remains uncertain (14).…”

Section: Discussionmentioning

confidence: 99%

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Neonatal and maternal thrombocytopenia: incidence and immune background

Uhrynowska

Niznikowska-Marks

Zupańska

2000

European J of Haematology

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We performed a prospective study on the incidence of thrombocytopenia (t-penia) and its immunological origin in unselected 26,275 mothers and 24,101 newborns. Platelet antibodies were examined by the platelet immunofluorescence test (PIFT) and the monoclonal antibody immobilisation of platelet antigens assay (MAIPA). T-penia (platelet count < 100 x 10(9)/I) was found in 124 (0.5%) mothers (in 0.04%) severe, <50x 10(9)/l) and in 116 (0.5%) newborns (in 0.15% severe); 90 (72.6%) and 112 (96.6%), respectively, were available for further studies. In both groups non-immune t-penia was diagnosed about 4.5 times more often than the immune t-penia. Among 90 mothers, t-penia was severe in 11.1%, antibodies were detected in 17.8%; both factors were not prognostic for delivering thrombocytopenic newborns. Among 112 babies, 21 were delivered by thrombocytopenic mothers and 91 by mothers with normal platelet count; among newborns with immune t-penia the proportion of alloimmune (NAIT) to autoimmune was equal (10 with NAIT, 10 with autoimmune, 4 of them born by mothers with hidden autoimmune t-penia). In 33% of the neonates t-penia was severe, most often among NAIT. In conclusion, although t-penia in mothers as well as in infants is not frequent and severe, and an immune origin not often found, the search for antibodies, in particular alloantibodies, should be done. Even if the serological results are not helpful at the moment, they can be of importance in subsequent pregnancy and for related pregnant women.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 79%

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Neonatal and maternal thrombocytopenia: incidence and immune background

Uhrynowska

Niznikowska-Marks

Zupańska

2000

European J of Haematology

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“…Neonatal alloimmune thrombocytopenia is common, with 1 in 1000 and 1 in 5000 pregnancies being at risk 12,13 . The syndrome is often compared with rhesus haemolytic disease of the newborn.…”

Section: Discussionmentioning

confidence: 99%

A case of thrombotic thrombocytopenic purpura and neonatal alloimmune thrombocytopenia in the same pregnancy

Richmond¹

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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Case reportA 26 year old primigravida with a past history of Hashimoto's thyroiditis required urgent admission at 21 weeks of gestation due to decreased level of consciousness, paraesthesiae of the right hand, slurred speech and difficulty in swallowing. The woman was disorientated and mildly febrile. There was no evidence of hypertension, bleeding or purpuric lesions. An automated blood count revealed normocytic anaemia (haemoglobin 48 g/L, MCV 97.8 fl), a haematocrit of 0.141 and thrombocytopenia (platelet count 14 Â 10 9 /L). Many schistocytes and nucleated red blood cells were present on the blood smear. Lactate dehydrogenase was elevated (1224 iu/L). Her clotting screen, liver and renal function tests were normal. Stool cultures were negative for E. coli 0157.Her clinical features were compatible with microangiopathy due to thrombotic thrombocytopenic purpura. She was treated with daily plasma exchange using cryo-poor plasma as a replacement fluid. A transfusion of red cell concentrate was also given, and calcium and folate supplements were prescribed.The woman responded well to plasma exchange, and her focal neurological signs resolved within three days. Ultrasonography revealed normal fetal anatomy and growth. Aspirin (81 mg daily) was begun when the platelet count rose above 50 Â 10 9 /L. Corticosteroids were administered a week after admission, while the diagnosis of autoimmune thrombocytopenia was still being entertained, and a betablocker was prescribed to control her borderline hypertension. Intramuscular betamethasone was given at 24 weeks of gestation to promote the production of surfactant in the infant's lungs. Blood counts stabilised with haemoglobin 80 -95 g/L, platelet count 230 Â 10 9 /L and lactate dehydrogenase 140-170 iu/L. Further laboratory analysis revealed no evidence of lupus anticoagulant, anticardiolipin antibodies, anti-nuclear antibodies or rheumatoid factor.She went home at 26 weeks of gestation, but continued with plasma exchange three times weekly and frequent ultrasonography. At 29 weeks of gestation, an ultrasound scan showed bilateral fetal intracerebral haemorrhages, and the woman was readmitted. Her platelet count, haemoglobin and lactate dehydrogenase levels were unchanged from her previous admission, suggesting no deterioration of her thrombotic thrombocytopenic purpura. In view of the haemorrhagic features in the fetus, a diagnosis of neonatal alloimmune thrombocytopenia was considered. Solvent detergent-treated intravenous immunoglobulin 1 g/kg was administered. The woman's genotype for platelet-specific antigens (HPA) was HPA-1b (PL A2/A2 ); her partner's genotype was HPA-1a (PL A1/A1 ). An anti-HPA-1a (anti-PL A1 ) antibody was identified in the mother's serum, confirming the diagnosis of neonatal alloimmune thrombocytopenia.Plasma exchanges were continued three times weekly, alternating with twice weekly infusions of immunoglobulin. Ultrasound scans of the fetal head were performed weekly. By 32 weeks of gestation, a porencephalic cyst measuring 29 Â 37 Â 26 mm was ...

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“…Neonatal alloimmune thrombocytopenia as a result of fetomaternal mismatch for human platelet alloantigens (HPAs) is the most common cause of severe thrombocytopenia in otherwise well term infants 1 . It is the result of a woman becoming alloimmunised during pregnancy to an antigen on fetal platelets of paternal origin.…”

Section: Introductionmentioning

confidence: 99%

Antenatal screening for human platelet antigen-1a: results of a prospective study at a large maternity hospital in Ireland

Davoren

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective Fetomaternal mismatch for human platelet antigen (HPA)-1a accounts for approximately 85% of cases of neonatal alloimmune thrombocytopenia. The purpose of the study was to determine the prevalence of the HPA-1a negative platelet phenotype in a cohort of pregnant women in Ireland, the rate of alloimmunisation to HPA-1a in HPA-1 mismatched pregnancies and the associated incidence of neonatal alloimmune thrombocytopenia. Design A prospective case -control study.Setting The antenatal clinics of a large maternity teaching hospital.Population or sample Pregnant women, regardless of parity, presenting at the antenatal clinics.Methods An enzyme-linked immunosorbent assay (ELISA) designed for simultaneous HPA-1a typing and antibody detection was used. Further analysis for HPA-1a alloantibodies was performed using commercial ELISA's (GTI PakPlus and Pak1) and the monoclonal antibody immobilisation of platelet antigens assay. Confirmation of serological typing was by the polymerase chain reaction technique using sequence-specific primers (PCR-SSP). Main outcome measures The presence of the HPA-1a negative phenotype and its association with the development of maternal anti-HPA-1a and infant thrombocytopenia. Results Eighty-four of 4090 consecutive women enrolled in the study tested positive for HPA-1a in the screening ELISA. Confirmatory genotyping was performed on 67 women (representing 80% of the cohort), and 54 women (representing 3272 non-selected pregnancies), were homozygous for the HPA-1b allele (1.7%). Three of 34 (9%) women who delivered HPA-1a positive babies had detectable anti-HPA-1a and all three babies had neonatal alloimmune thrombocytopenia, for an overall incidence of 1:1100 non-selected pregnancies. Conclusions The observed prevalence of 1.7% for the HPA-1a negative platelet phenotype is as expected from studies in other countries. While we have demonstrated the practicability of antenatal HPA-1a screening, further research is warranted to investigate maternal parameters predictive of severe fetal thrombocytopenia in HPA-1a alloimmunised pregnancies.

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Frequency of Immune Thrombocytopenia in Newborns: A Prospective Study

Cited by 285 publications

References 20 publications

Neonatal and maternal thrombocytopenia: incidence and immune background

Neonatal and maternal thrombocytopenia: incidence and immune background

A case of thrombotic thrombocytopenic purpura and neonatal alloimmune thrombocytopenia in the same pregnancy

Antenatal screening for human platelet antigen-1a: results of a prospective study at a large maternity hospital in Ireland

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