High-dose IgG treatment for neonatal alloimmune thrombocytopenia

Mueller‐Eckhardt, C.; Kiefel, V.; Grubert, Alfons

doi:10.1007/bf00320268

Cited by 61 publications

(32 citation statements)

References 12 publications

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“…Alloantibodies against platelet-specific alloantigens, in particular HPA-1a, can cause severe thrombocytopenia, which may require treatment with high-dose intravenous immune globulin and plasma exchange. 8,9 Neither of the kidney-transplant recipients we studied had a response to these therapies. Patient 2 died of multiorgan failure and bowel perforation related to a he- t r a n s p l a n t a t i o n P a t i e n t 1 a f t e r t r a n s p l a n t a t i o n O r g a n matoma in the bowel wall.…”

Section: Discussionmentioning

confidence: 99%

Alloimmune Thrombocytopenia after Organ Transplantation

West¹,

Anderson²,

McAlister

et al. 1999

N Engl J Med

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Section: Discussionmentioning

confidence: 99%

Alloimmune Thrombocytopenia after Organ Transplantation

West¹,

Anderson²,

McAlister

et al. 1999

N Engl J Med

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“…Small and non-randomised studies have shown that the infusion of IVIG may produce a rise in platelet count in 75% of cases 8. A dosage of 1 g/kg body weight for 2 days or 400 mg/kg for 5 days instead of 3×0.8 g/kg in 1 week might have been more efficient.…”

Section: Discussionmentioning

confidence: 99%

Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies

Wendel¹,

Akkök

Kutzsche

2017

BMJ Case Reports

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Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant's father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum. Weak antibodies against HLA-B57 and HLA-B58 in sera from both twins supported NAIT as the most likely diagnosis. Platelet transfusion requirements of the twins lasted for 7 weeks. Transfusion of HLA-matched platelet concentrates was more efficacious to manage thrombocytopaenia compared with platelet concentrates from random donors. Platelet genotyping and determination of HLA antibody specificity are needed to select compatible platelet units to expedite safe recovery from thrombocytopaenia in NAIT.

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“…The usual recommended dose of IVIG is 2 g per kg administered either as 0.4 g per kg daily for 5 days or as 1 g per kg on 2consecutive days, the latter regimen being preferentially selected in our survey 8 . High‐dose IVIG has been repeatedly reported to be effective in cases of NAIT; however, the evidence derives from small case reports without a control group 24‐26 …”

Section: Discussionmentioning

confidence: 99%

A systematic review and survey of the management of unexpected neonatal alloimmune thrombocytopenia

Bassler

Greinacher²,

Okascharoen³

et al. 2007

Transfusion

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BACKGROUND: Unexpected neonatal alloimmune thrombocytopenia (NAIT) may have devastating consequences and its management is challenging. To design future trials, evidence from the literature and existing best practice need review. STUDY DESIGN AND METHODS: This study was a cross‐sectional survey of neonatal units in Germany and Canada to determine management strategies of NAIT and a systematic search for randomized controlled trials (RCTs). RESULTS: Management of NAIT differs substantially between countries with regard to platelet (PLT) thresholds for screening, initiation of therapy, and treatment. Seventy‐seven percent of Canadian physicians versus 68 percent of German physicians screen preterm and term infants, at a PLT threshold of 30 × 109 to 100 × 109 per L. In preterm infants, 60 percent of Canadian neonatologists commence treatment at a PLT count of between 30 × 109 and 50 × 109 per L. In Germany 32 percent of the physicians start treatment at this level and 25 percent use a threshold of between 10 × 109 and 20 × 109 per L. In term infants, 6 percent of the Canadian physicians and 16 percent of the German physicians use even lower treatment triggers of between 5 × 109 and 10 × 109 per L. In the presence of bleeding, 61 percent of German physicians await the arrival of antigen‐negative PLTs, while 64 percent of Canadian neonatologists prefer intravenous immunoglobulin or random‐donor PLTs (81%). Maternal PLTs are utilized by 31 percent of physicians in both countries. No RCTs were identified. CONCLUSION: In the absence of RCTs, management of unexpected NAIT differs between countries. Clinicians and transfusion services may use the results of our study to develop collaborative protocols, redefine preferred hospitalwide strategies, and design future controlled trials.

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High-dose IgG treatment for neonatal alloimmune thrombocytopenia

Cited by 61 publications

References 12 publications

Alloimmune Thrombocytopenia after Organ Transplantation

Alloimmune Thrombocytopenia after Organ Transplantation

Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies

A systematic review and survey of the management of unexpected neonatal alloimmune thrombocytopenia

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