title: Management of infants born with severe neonatal alloimmune thrombocytopenia: the role of platelet transfusions and intravenous immunoglobulin.
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  RESULTS
  All but one patient (treated with random PLTs and IVIG) achieved a posttransfusion PLT count of higher than 30 × 10(9) /L after the first PLT transfusion. The PLT count remained higher than 30 × 10(9) /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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute for Immunology and Transfusion Medicine, University Children's Hospital, Universitätsmedizin Greifswald, Greifswald, Germany; Department of Neonatology, University Children's Hospital, Universitätsmedizin Greifswald, Greifswald, Germany; Department of Neonatology, University Children's Hospital, Tuebingen, Germany; Department of Transfusion Medicine, University of Rostock, Rostock, Germany; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, Neonatal Division, McMaster University, Hamilton, Ontario, Canada; Canadian Blood Services, Hamilton, Ontario, Canada.
authors.forename: Tamam
authors.initials: T
authors.lastname: Bakchoul
authors.forename: Dirk
authors.initials: D
authors.lastname: Bassler
authors.forename: Matthias
authors.initials: M
authors.lastname: Heckmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Thiele
authors.forename: Volker
authors.initials: V
authors.lastname: Kiefel
authors.forename: Isabel
authors.initials: I
authors.lastname: Gross
authors.forename: Donald M
authors.initials: DM
authors.lastname: Arnold
authors.forename: Julie
authors.initials: J
authors.lastname: DiTomasso
authors.forename: James W
authors.initials: JW
authors.lastname: Smith
authors.forename: Bosco
authors.initials: B
authors.lastname: Paes
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
mesh_terms: D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D008297:Male; D017713:Platelet Transfusion; D012189:Retrospective Studies; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous