A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia

• Published in: Blood Vol. 110; no. 3; pp. 833 - 839
• Main Authors: Kjeldsen-Kragh, Jens, Killie, Mette Kjær, Tomter, Geir, Golebiowska, Elzbieta, Randen, Ingrid, Hauge, Reidun, Aune, Berit, Øian, Pål, Dahl, Lauritz B., Pirhonen, Jouko, Lindeman, Rolf, Husby, Henrik, Haugen, Guttorm, Grønn, Morten, Skogen, Bjørn, Husebekk, Anne
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 01.08.2007; The Americain Society of Hematology
• Subjects: Adult; Antigens, Human Platelet - blood; Antigens, Human Platelet - immunology; Biological and medical sciences; Blood Grouping and Crossmatching; Blood Transfusion; Cesarean Section; Female; Fetal Death - blood; Fetal Death - immunology; Fetal Death - prevention & control; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Immunization; Infant, Newborn; Infant, Newborn, Diseases - blood; Infant, Newborn, Diseases - immunology; Infant, Newborn, Diseases - mortality; Infant, Newborn, Diseases - prevention & control; Intracranial Hemorrhages - blood; Intracranial Hemorrhages - immunology; Intracranial Hemorrhages - mortality; Intracranial Hemorrhages - prevention & control; Male; Medical sciences; Neonatal Screening; Platelet Count; Platelet diseases and coagulopathies; Pregnancy; Stillbirth; Thrombocytopenia - blood; Thrombocytopenia - immunology; Thrombocytopenia - mortality; Thrombocytopenia - prevention & control; Human; Isoimmunization; Thrombocytopenia; Neonatal; Platelet; Newborn; Program; Hematology; Mortality; Hemopathy; Medical screening; Morbidity
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2006-08-040121

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 × 109/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 × 109/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.