Fetale und neonatale Alloimmunthrombozytopenie

Mütterliche Antikörper, die gegen ein vom Vater ererbtes Blutgruppenmerkmal an fetalen Thrombozyten gerichtet sind, können eine fetale oder neonatale Alloimmunthrombozytopenie (FNAIT) hervorrufen. Durch eine frühzeitige Erkennung und Behandlung dieser Erkrankung können schwerwiegende Komplikationen bei den betroffenen Feten oder Neugeborenen sowie in einer Folgeschwangerschaft verhindert werden.

Kernaussagen

• Die fetale und neonatale Alloimmunthrombozytopenie (FNAIT) wird durch mütterliche Antikörper hervorgerufen, die gegen ein vom Vater ererbtes Blutgruppenmerkmal auf fetalen Thrombozyten gerichtet sind, meist HPA-1a.

• Die Immunisierung gegen Thrombozytenantigene mit konsekutiver Thrombozytopenie tritt meist schon in der 1. Schwangerschaft auf.

• Die FNAIT ist eine der wichtigsten Ursache einer isolierten, schweren neonatalen Thrombozytopenie.

• Bei kaukasischer Ethnizität wird die FNAIT in der Mehrzahl der Fälle durch mütterliche Anti-HPA-1a-Antikörper hervorgerufen.

• Eine intrakranielle Blutung infolge einer FNAIT kommt in 1:10.000–100.000 Geburten vor. Die Mehrheit der intrakraniellen Blutungen (ca. 55%) treten vor der 28. SSW auf und betreffen überwiegend das Erstgeborene (ca. 60%).

• Die perinatale Mortalität und der Anteil an Kindern mit schweren neurologischen Defiziten nach intrakranieller Blutung ist hoch.

• Eine frühzeitige Betreuung von Risikoschwangeren durch ein multidisziplinäres Team an Zentren mit entsprechender Expertise sollte erfolgen.

Schlüsselwörter

Neonatologie - FNAIT - fetale Alloimmunthrobozytopathie - neonatale Alloimmunthrobozytopathie - intrakraniale Hämorrhagie - ICH - fetale Hirnblutung

Publication History

Article published online:
25 February 2025

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