A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia.
The study's objective was to identify HPA 1a-negative women and to offer them an intervention program aimed to reduce morbidity and mortality of neonatal alloimmune thrombocytopenia (NAIT). HPA 1 typing was performed in 100 448 pregnant women. The HPA 1a-negative women were screened for anti-HPA 1a. In immunized women, delivery was performed by Cesarean section 2 to 4 weeks prior to term, with platelets from HPA 1a-negative donors reserved for immediate transfusion if petechiae were present and/or if platelet count was less than 35 x 10(9)/L. Of the women screened, 2.1% were HPA 1a negative, and anti-HPA 1a was detected in 10.6% of these. One hundred seventy pregnancies were managed according to the intervention program, resulting in 161 HPA 1a-positive children. Of these, 55 had severe thrombocytopenia (< 50 x 10(9)/L), including 2 with intracranial hemorrhage (ICH). One woman with a twin pregnancy missed the follow-up and had one stillborn and one severely thrombocytopenic live child. In 15 previous prospective studies (136 814 women) there were 51 cases of severe NAIT (3 intrauterine deaths and 7 with ICH). Acknowledging the limitation of comparing with historic controls, implementation of our screening and intervention program seemed to reduce the number of cases of severe NAIT-related complications from 10 of 51 to 3 of 57.
Kjeldsen-Kragh
Jens
J
Department of Immunity, Ullevål University Hospital, 0407 Oslo, Norway. jens.kjeldsen-kragh@medisin.uio.no
Killie
Mette Kjaer
MK
Tomter
Geir
G
Golebiowska
Elzbieta
E
Randen
Ingrid
I
Hauge
Reidun
R
Aune
Berit
B
Øian
Pål
P
Dahl
Lauritz B
LB
Pirhonen
Jouko
J
Lindeman
Rolf
R
Husby
Henrik
H
Haugen
Guttorm
G
Grønn
Morten
M
Skogen
Bjørn
B
Husebekk
Anne
A
D000328:Adult; D016824:Antigens, Human Platelet / Q000097:blood* / Q000276:immunology; D001788:Blood Grouping and Crossmatching; D001803:Blood Transfusion; D002585:Cesarean Section; D005260:Female; D005313:Fetal Death / Q000097:blood / Q000276:immunology / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D007114:Immunization; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood* / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D039661:Integrin beta3; D020300:Intracranial Hemorrhages / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000517:prevention & control; D008297:Male; D015997:Neonatal Screening; D010976:Platelet Count; D011247:Pregnancy; D050497:Stillbirth; D013921:Thrombocytopenia / Q000097:blood* / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*
D016824:Antigens, Human Platelet; C061248:ITGB3 protein, human; D039661:Integrin beta3