Contemporary management of neonatal alloimmune thrombocytopenia: good outcomes in the intravenous immunoglobulin era: results from the Australian neonatal alloimmune thrombocytopenia registry.
OBJECTIVE
To describe the natural history, antenatal and postnatal therapy, and clinical outcomes of Australian patients with fetomaternal/neonatal alloimmune thrombocytopenia (NAIT) recorded in the Australian NAIT registry.


METHODS
Analysis of registry data of Australian mothers treated antenatally for NAIT and any fetus/newborn with thrombocytopenia (TCP) and maternal human platelet antigen (HPA) antibodies.


RESULTS
Ninety four potential cases (91 pregnancies; three twin pregnancies) were registered between December 2004 and September 2015 with 76 confirmed or treated as NAIT. NAIT was frequently unanticipated (44 cases, 58%), whilst 32 cases (42%) were anticipated due to personal or family history. In 70/76 cases, the diagnosis of NAIT was made based on HPA antibody results; anti-HPA-1a was most commonly detected (58/70, 82%), followed by anti-HPA-5b (5/70, 7%). Intracranial haemorrhage (ICH) was detected in seven cases (9%). Maternal antenatal therapy resulted in improved clinical outcomes. For antenatally treated cases, whilst 10/29 (34%) neonates had severe TCP, only one ICH was detected.


CONCLUSIONS
This study provides data on contemporary "real world" management of Australian mothers and babies with NAIT. Antenatal IVIG therapy was associated with better neonatal outcomes. Maternal side-effects and treatment costs were substantial.
a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia.|b Australian Red Cross Blood Service , Melbourne , Australia.|c The Royal Children's Hospital , Melbourne , Australia.
Gemma L
GL
Crighton
a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia.
Ri
R
Scarborough
a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia.|d Australia and New Zealand Intensive Care Research Centre (ANZIC-RC) , Melbourne , Australia.
Zoe K
ZK
McQuilten
a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia.
Louise E
LE
Phillips
c The Royal Children's Hospital , Melbourne , Australia.|e The Royal Women's Hospital , Melbourne , Australia.
Helen F
HF
Savoia
f Royal Brisbane and Women's Hospital , Brisbane , Australia.|g Lady Cilento Children's Hospital , Brisbane , Australia.
Bronwyn
B
Williams
b Australian Red Cross Blood Service , Melbourne , Australia.
Rhonda
R
Holdsworth
h School of Women's and Children's Health, University of New South Wales , Australia.|i St George Hospital , Sydney , Australia , and.
Amanda
A
Henry
a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia.|j Monash Medical Centre , Melbourne , Australia.
Erica M
EM
Wood
e The Royal Women's Hospital , Melbourne , Australia.
Stephen A
SA
Cole
D000328:Adult; D001315:Australia; D005260:Female; D046128:Fetal Therapies / Q000706:statistics & numerical data*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007231:Infant, Newborn; D011247:Pregnancy; D012042:Registries; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000188:drug therapy*
D016756:Immunoglobulins, Intravenous
Fetomaternal/neonatal alloimmune thrombocytopenia; human platelet antigen; intracranial haemorrhage; intravenous immunoglobulin; neonatal thrombocytopenia