This study was supported by the German Federal Ministry for Education and Research (CAN04/006; ZIK-HIKE FKZ 03Z2CN11; 03Z2CN12) and the “Forschungsverbund Molekulare Medizin” of the Ernst-Moritz-Arndt University Greifswald.
Management of infants born with severe neonatal alloimmune thrombocytopenia: the role of platelet transfusions and intravenous immunoglobulin
Article first published online: 19 JUL 2013
© 2013 American Association of Blood Banks
Volume 54, Issue 3, pages 640–645, March 2014
How to Cite
Bakchoul, T., Bassler, D., Heckmann, M., Thiele, T., Kiefel, V., Gross, I., Arnold, D. M., DiTomasso, J., Smith, J. W., Paes, B. and Greinacher, A. (2014), Management of infants born with severe neonatal alloimmune thrombocytopenia: the role of platelet transfusions and intravenous immunoglobulin. Transfusion, 54: 640–645. doi: 10.1111/trf.12336
- Issue published online: 11 MAR 2014
- Article first published online: 19 JUL 2013
- Manuscript Accepted: 22 MAY 2013
- Manuscript Revised: 10 MAY 2013
- Manuscript Received: 19 MAR 2013
- German Federal Ministry for Education and Research. Grant Numbers: CAN04/006, ZIK-HIKE FKZ 03Z2CN11, 03Z2CN12
- “Forschungsverbund Molekulare Medizin” of the Ernst-Moritz-Arndt University Greifswald
Neonatal alloimmune thrombocytopenia (NAIT) is a fetomaternal incompatibility most commonly induced by maternal anti-HPA-1a alloantibodies. Transfusion of immunologically compatible platelets (PLTs) to prevent cerebral hemorrhage, the most severe complication in affected newborns, is usually recommended. Such PLT concentrates, however, are often not readily available.
Study Design and Methods
The efficacy of random-donor PLT transfusions and intravenous immunoglobulin (IVIG) for the management of 17 neonates across four centers with unexpected, severe NAIT was evaluated. Neonates were treated with random-donor PLTs alone (n = 7), random-donor PLTs with IVIG (n = 8), or matched HPA-1bb PLTs (n = 2).
All but one patient (treated with random PLTs and IVIG) achieved a posttransfusion PLT count of higher than 30 × 109/L after the first PLT transfusion. The PLT count remained higher than 30 × 109/L for longer than 24 hours in five of seven, seven of eight, and two of four newborns who received random-donor PLTs alone, random-donor PLTs with IVIG, or matched HPA-1bb PLTs, respectively. None of the newborns developed major bleeding or intracranial hemorrhage. IVIG did not appear to improve either posttransfusion PLT counts or total PLT transfusion requirements.
Transfusion of random-donor PLTs alone was effective at correcting critically low PLT counts and should be considered as first-line treatment of newborns with unexpected severe NAIT.