Clinical Review Lesson of the week

Neonatal alloimmune thrombocytopenia

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7410.331 (Published 07 August 2003) Cite this as: BMJ 2003;327:331
  1. R Rayment, research fellow1,
  2. J Birchall, specialist registrar2,
  3. H Yarranton, specialist registrar3,
  4. J Hewertson, consultant paediatrician4,
  5. D Allen, head of platelet immunology laboratory1,
  6. M F Murphy, consultant haematologist1,
  7. D J Roberts, consultant haematologist1 (david.roberts@ndcls.ox.ac.uk)
  1. 1 National Blood Service, John Radcliffe Hospital, Oxford OX3 9DU
  2. 2National Blood Service, Southmead Hospital, Bristol BS10 5ND
  3. 3 Department of Haematology, Norfolk and Norwich University Hospital NHS Trust, Norwich NR4 7UY
  4. 4Northampton General Hospital, Northampton NN1 5BD
  1. Correspondence to: D J Roberts
  • Accepted 22 July 2002

Introduction

Neonatal alloimmune thrombocytopenia—caused by movement of maternal alloantibodies directed against fetal platelet antigens across the placenta—is the most common cause of severe neonatal thrombocytopenia.1 These alloantibodies cause thrombocytopenia, which may result in intracranial haemorrhage.2 3 Most cases arise unexpectedly, and prompt diagnosis and treatment are essential to reduce the chances of death and disability caused by the haemorrhaging.4 5 Neonatal alloimmune thrombocytopenia should be strongly suspected in cases of neonatal thrombocytopenia with no evidence of sepsis, systemic disease, or skeletal anomalies associated with thrombocytopenia, and where maternal idiopathic thrombocytopenic pupura has been excluded. We describe two cases with typical clinical presentations in which standard methods for detection of maternal antibodies gave negative results, and we show that empirical treatment with human platelet antigen 1a negative platelets yielded successful outcomes in both cases.

Case 1

A two day old girl presented with several left sided and secondary generalised tonic-clonic seizures. She had been delivered normally at full term, after an uneventful gestation. Neurological examination between seizures had normal results, and otherwise she was completely well.

Her platelet count was 5x109/l, haemoglobin concentration was 158 g/l, and white cell count was 16.7x109/l. A magnetic resonance scan showed fresh extensive haemorrhage in the interhemispheric fissure and sulci (1). The brain and ventricles were normal. Viral swabs and culture showed no infectious cause for the thrombocytopenia. The baby's mother had a normal platelet count.

Fig 1

Magnetic resonance image showing fresh extensive haemorrhage in the interhemispheric fissure and sulci (case 1) …

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