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Neonatal Thrombocytopenia

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Management of Bleeding Patients

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Abstract

Thrombocytopenia is very common in neonates. Severity may vary with the causes, which may be immune or non-immune. While thrombocytopenia in sick infants often needs only supportive care, thrombocytopenia in otherwise well infants requires immediate investigation and management. Fetal maternal alloimmune thrombocytopenia (FMAIT) is a common cause of severe thrombocytopenia in otherwise well babies and has a significant risk of intracerebral haemorrhage if not treated promptly. There are a variety of congenital syndromes that are associated with thrombocytopenia in the neonate, and a stepwise logical approach to diagnosis and therapy is required.

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References

  1. Dreyfus M, Kaplan C, Verdy E, Schlegel N, Durand-Zaleski I, Tchernia G. Frequency of immune thrombocytopenia in newborns: a prospective study. Blood. 1997;89(12):4402–6.

    CAS  PubMed  Google Scholar 

  2. Holzhauer SZ, Zieger B. Diagnosis and management of neonatal thrombocytopenia. Semin Fetal Neonatal Med. 2011;16:305–10.

    Article  PubMed  Google Scholar 

  3. Sainio S, Jarvenpaa A-L, Renlund M, Riikonen S, Teramo K, Kekomaki R. Thrombocytopenia in term infants: a population based study. Obstet Gynaecol. 2000;95(3):441–6.

    CAS  Google Scholar 

  4. Mueller-Eckhardt C, Grubert A, Weisheit M, Mueller-Eckhardt G. 348 cases of suspected neonatal alloimmune thrombocytopenia. Lancet. 1989;1:363–6.

    Article  CAS  PubMed  Google Scholar 

  5. Bonacossa IAJ, Jocelyn LJ. Alloimmune thrombocytopenia of the newborn: neurodevelopmental sequelae. Am J Perinatol. 1996;13(4):211–5.

    Article  CAS  PubMed  Google Scholar 

  6. Kaplan C. Neonatal alloimmune thrombocytopenia. Haematologica. 2008;93:805–7.

    Article  PubMed  Google Scholar 

  7. van den Akker ESA. Fetal and neonatal alloimmune thrombocytopenia. Best Pract Res Clin Obstet Gynaecol. 2008;22(1):3–14.

    Article  PubMed  Google Scholar 

  8. Spencer JAB, Burrows RF. Feto-maternal alloimmune thrombocytopenia: a literature review and statistical analysis. Aust N Z J Obstet Gynaecol. 2001;41(1):45–55.

    Article  CAS  PubMed  Google Scholar 

  9. Davoren A, Curtis BR, Aster RH, McFarland JG. Human platelet antigen-specific alloantibodies implicated in 1162 cases of neonatal alloimmune thrombocytopenia. Transfusion. 2004;44:1220–5.

    Article  CAS  PubMed  Google Scholar 

  10. von dem Borne AED, Decary F. Nomenclature of platelet specific antigens. Br J Haematol. 1990;74:239–40.

    Article  Google Scholar 

  11. McQuilten ZK, Wood EB, Savoia H, Cole S. A review of pathophysiology and current treatment for neonatal alloimmune thrombocytopenia (NAIT) and introducing the Australian NAIT registry. Aust N Z J Obstet Gynaecol. 2011;51:191–8.

    Article  PubMed  Google Scholar 

  12. Jaegtvik S, Husebekk A, Aune B, Oian P, Dahl LB, Skogen B. Neonatal alloimmune thrombocytopenia due to anti-HPA 1a antibodies; the level of maternal antibodies predicts the severity of thrombocytopenia in the newborn. Br J Obstet Gynaecol. 2000;107:691–4.

    Article  CAS  Google Scholar 

  13. Turner ML, Bessos H, Fagge T, Harkness M, Renoul F, Seymour J, Wilson D, Gray I, Ahya R, Cairns J, Urbaniak S. Prospective epidemiologic study of the outcome and cost-effectiveness of antenatal screening to detect neonatal alloimmune thrombocytopenia due to anti-HPA-1a. Transfusion. 2005;45:1945–56.

    Article  CAS  PubMed  Google Scholar 

  14. Durand-Zaleski I, Schlegel N, Blum-Boisgard C, Uzan S, Dreyfus M, Kaplan C. Screening primiparous women and newborns for fetal/neonatal alloimmune thrombocytopenia: a prospective comparison of effectiveness and costs. Am J Perinatol. 1996;13(7):423–31.

    Article  CAS  PubMed  Google Scholar 

  15. Killie MK, Husebekk A, Kjeldsen-Kragh J, Skogen B. A prospective study of maternal anti-HPA-1a antibody level as a potential predictor of alloimmune thrombocytopenia in the newborn. Haematologica. 2008;93(6):870–7.

    Article  CAS  PubMed  Google Scholar 

  16. Loewenthal R, Rosenberg N, Kalt R, Dardik R, Landau M, Yahalom V, Avishai O, Frenkel O, Gazit E, Steinberg M, Lipitz S, Salomon O. Compound heterozygosity of HLA-DDRB3*01:01 and HLA-DRB4*01:01 as a potential predictor of fetal neonatal alloimmune thrombocytopenia. Transfusion. 2013;53(2):344–52.

    Article  CAS  PubMed  Google Scholar 

  17. Williamson LM, Hacketss G, Rennie J, Palmer CR, Maciver C, Hadfield R, Hughes D, Jobson S, Ouwehand WH. The natural history of fetomaternal alloimmunization to the platelet-specific antigen HPA-1a (PIaA1, ZWa) as determined by antenatal screening. Blood. 1998;92(7):2280–7.

    CAS  PubMed  Google Scholar 

  18. Kay HH, Hage ML, Kurtzberg J, Dunsmore KP. Alloimmune thrombocytopenia may be associated with systemic disease. Am J Obstet Gynaecol. 1992;166(1):110–1.

    Article  CAS  Google Scholar 

  19. Curtis BR. Recent progress in understanding the pathogenesis of fetal and neonatal alloimmune thrombocytopenia. Br J Haematol. 2015;171:671–82.

    Article  PubMed  Google Scholar 

  20. Birchall JE, Murphy MF, Kaplan C, Kroll H, On behalf of the European Fetomaternal Alloimmune Thrombocytopenia Study Group. European collaborative study of the antenatal management of feto-maternal alloimmune thrombocytopenia. Br J Haematol. 2003;122:275–88.

    Article  PubMed  Google Scholar 

  21. Dale STC, Coleman LT. Neonatal alloimmune thrombocytopenia: antenatal and postnatal imaging findings in the pediatric brain. AJNR Am J Neuroradiol. 2002;23:1457–65.

    PubMed  Google Scholar 

  22. Sachs UJ. Fetal/neonatal alloimmune thrombocytopenia. Thromb Res. 2013;131 Suppl 1:S42–6.

    Article  CAS  PubMed  Google Scholar 

  23. Bertrand C, Martageix C, Jallu V, Vitry F, Kaplan C. Predictive value of sequential maternal anti-HPA-1a antibody concentrations for the severity of fetal alloimmune thrombocytopenia. J Thromb Haemost. 2006;4:628–37.

    Article  CAS  PubMed  Google Scholar 

  24. Kaplan C, Murphy MF, Kroll H, Waters AH. Feto-maternal alloimmune thrombocytopenia: antenatal therapy with IvIgG and steroids - more questions than answers. Br J Haematol. 1998;100:62–5.

    Article  CAS  PubMed  Google Scholar 

  25. Porcelijn L, Van den Akker ESA, Oepkes D. Fetal thrombocytopenia. Semin Fetal Neonatal Med. 2008;13:223–30.

    Article  CAS  PubMed  Google Scholar 

  26. Kaplan C, Daffos F, Forestier F, Cox WL, Lyon-Caen D, Dupuy-Montrun MC, Salmon C. Management of alloimmune thrombocytopenia: antenatal diagnosis and in utero transfusion of maternal platelets. Blood. 1988;72(1):340–3.

    CAS  PubMed  Google Scholar 

  27. Bussel JB, Zabusky MR, Berkowitz RL, McFarland JG. Fetal alloimmune thrombocytopenia. N Engl J Med. 1997;337(1):22–6.

    Article  CAS  PubMed  Google Scholar 

  28. Kiefel V, Bassler D, Kroll H, Paes B, Giers G, Ditomasso J, Alber H, Berns M, Wiebe B, Quenzel E-M, Hoch J, Greinacher A. Antigen-positive platelet transfusion in neonatal alloimmune thrombocytopenia (NAIT). Blood. 2006;107(9):3761–3.

    Article  CAS  PubMed  Google Scholar 

  29. Allen D, Verjee S, Rees S, Murphy MF, Roberts DJ. Platelet transfusion in neonatal alloimmune thrombocytopenia. Blood. 2007;109(1):388–9.

    Article  CAS  PubMed  Google Scholar 

  30. Bussel JBS-V, Sola-Visner M. Current approaches to the evaluation and management of the fetus and neonate with immune thrombocytopenia. Semin Perinatol. 2009;33(1):35–42.

    Article  PubMed  Google Scholar 

  31. Killie MK, Kjeldsen-Kragh J, Husebekk A, Skogen B, Olsen JA, Kristiansen IS. Cost-effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia. Br J Obstet Gynaecol. 2007;114:588–95.

    Article  CAS  Google Scholar 

  32. Kjeldsen-Kragh J, Killie MK, Tomter G, Golebiowska E, Randen I, Hauge R, Aune B, Oian P, Dahl LB, Pirhonen J, Lindeman R, Husby H, Haugen G, Gronn M, Skogen B, Husebekk A. A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia. Blood. 2007;110:833–9.

    Article  CAS  PubMed  Google Scholar 

  33. Burrows RFK, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993;329:1463–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Haematology, Royal Children’s Hospital, 50 Flemington Road, Parkville, Melbourne, 3052, Australia

    Rebecca Barton M.B.B.S., B.Bio.Med.Sc. & Paul Monagle M.B.B.S, M.D, F.R.C.P.A, F.C.C.P

  2. Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, 50 Flemington Road, Parkville, Melbourne, 3052, Australia

    Paul Monagle M.B.B.S, M.D, F.R.C.P.A, F.C.C.P

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  1. Rebecca Barton M.B.B.S., B.Bio.Med.Sc.
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Correspondence to Paul Monagle M.B.B.S, M.D, F.R.C.P.A, F.C.C.P .

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Editors and Affiliations

  1. Departments of Pathology & Immunology, Pediatrics, and Medicine, Baylor College of Medicine Division of Transfusion Medicine & Coagulation Texas Children’s Hospital, Houston, Texas, USA

    Jun Teruya

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Barton, R., Monagle, P. (2016). Neonatal Thrombocytopenia. In: Teruya, J. (eds) Management of Bleeding Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-30726-8_32

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  • DOI: https://doi.org/10.1007/978-3-319-30726-8_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30724-4

  • Online ISBN: 978-3-319-30726-8

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