Intrauterine use of hyperconcentrated platelet concentrates collected with Trima Accel in a case of neonatal alloimmune thrombocytopenia.
BACKGROUND
Due to the threat of serious or fatal bleedings, fetuses with neonatal alloimmune thrombocytopenia (NAIT) may need intrauterine platelet (PLT) transfusions. To prevent a volume overload or an ABO minor mismatch, standard PLT concentrates need to be washed to increase the PLT concentration and to reduce the plasma content. Hyperconcentrated single-donor PLT concentrates (HCPs) are a therapeutic alternative. The first case of NAIT successfully treated with HCPs collected with the Trima Accel (TA; Gambro BCT) is reported.


METHODS
A 31-year-old woman with a history of NAIT in the preceding pregnancy underwent cordocentesis three times during her third pregnancy (30th, 31st, and 32nd weeks of gestation). NAIT was confirmed by marked fetal thrombocytopenia, a maternal anti-human PLT antigen (HPA)-1a-immunoglobulin G (titer 1:128), and the appropriate HPA genotype of the fetus and the parents. On each cordocentesis procedure, a distinct volume of a HPA-1a-negative HCP with a PLT concentration of 3 x 10(6) PLTs per microL was transfused resulting in high corrected count increments after 2 hours. The HCPs were transfused within 10 hours after collection. One day after the last cordocentesis procedure, a cesarean section was performed. The newborn did not show any bleeding signs, and the PLT count remained on normal levels and no further PLT transfusions were needed.


CONCLUSIONS
HCPs collected with TA are a useful alternative to washed standard PLT concentrates without the need for further manipulation of the product after collection. Further in vitro and in vivo studies are needed, however, to make definite recommendations for the shelf life of these HCP.
Ringwald
Juergen
J
Department of Transfusion Medicine and Hemostaseology, University Hospital of Erlangen, Krankenhausstrasse 12, D-91054 Erlangen, Germany. Juergen.Ringwald@trans.imed.uni-erlangen.de
Schroth
Michael
M
Faschingbauer
Florian
F
Strobel
Julian
J
Strasser
Erwin
E
Schild
Ralf L
RL
Goecke
Tamme W
TW
D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D017218:Cordocentesis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007519:Isoantigens / Q000276:immunology*; D017713:Platelet Transfusion; D013921:Thrombocytopenia / Q000628:therapy*
D007519:Isoantigens