Am J Perinatol 2018; 35(S 01): S1-S26
DOI: 10.1055/s-0038-1647095
Abstracts
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment and Outcomes of Fetal/Neonatal Alloimmune Thrombocytopenia: A Nationwide Cohort Study on Newly Detected Cases

D. Winkelhorst
1   Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
2   Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
,
M. Oostweegel
3   Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
,
L. Porcelijn
2   Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
,
R. A. Middelburg
4   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
5   Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
,
J. J. Zwaginga
5   Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
6   Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
,
D. Oepkes
1   Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
,
J. G. van der Bom
4   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
5   Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
6   Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
*   These authors contributed equally to this work
,
M. de Haas
2   Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
*   These authors contributed equally to this work
,
E. Lopriore
2   Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
27 April 2018 (online)

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    Introduction: Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is the most important cause of thrombocytopenia in term-born infants and can cause severe hemorrhages. Postnatal management strategies aim to reduce bleeding tendency by increasing platelet counts, but evidence for the optimal treatment is lacking. We reviewed postnatal management strategies and outcomes of patients with FNAIT, diagnosed, and treated in the first week of life.

    Materials and Methods: We performed a nationwide cohort study comprising all newborns with newly detected FNAIT born between January 1, 2006, and January 1, 2017, in the Netherlands. Antibodies against human platelet antigens (HPAs) were measured and maternal–fetal HPA incompatibility was confirmed. Data on postnatal management and outcomes were gathered from medical files and laboratory information systems.

    Results: The cohort comprised 102 cases. Postnatal strategies included no treatment (n = 34), platelet transfusion (PTx) with compatible (n = 24) or random-donor platelets (n = 16), or both (n = 6), and intravenous immunoglobulin (IVIG) (with (n = 9) or without PTx (n = 9)). In all strategies, a median platelet count >50 × 109/L was reached within 4 days after birth without the occurrence of new hemorrhages. Highest and fastest increments in platelet count were observed after HPA-compatible PTx, median platelet count 151 × 109/L at 5 days of age. Treatment with IVIG was associated with the smallest increment in platelet counts, median platelet count 67 × 109/L at day 6. Random-donor PTx were not associated with a higher use of additional PTxs.

    Conclusion: Our data suggest that treatment with “IVIG only” is less efficacious and that if HPA-compatible platelets are not directly available transfusion with random-donor platelets may be a more appropriate first-line therapy in FNAIT.


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    No conflict of interest has been declared by the author(s).