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Reminder of important clinical lesson
CASE REPORT
Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies
  1. Kristina Wendel1,
  2. Çiğdem Akalin Akkök2,3,
  3. Stefan Kutzsche4
  1. 1Department of Paediatrics, Oslo Universitetssykehus, Oslo, Norway
  2. 2Department of Immunology and Transfusion Medicine, Oslo Universitetssykehus, Oslo, Norway
  3. 3University and Regional Laboratories, Department of Clinical Immunology and Transfusion Medicine, Lund University, Lund, Sweden
  4. 4Centre for Education, International Medical University, Kuala Lumpur, Malaysia
  1. Correspondence to Dr Stefan Kutzsche, stefankutzsche{at}imu.edu.my

Summary

Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant’s father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum. Weak antibodies against HLA-B57 and HLA-B58 in sera from both twins supported NAIT as the most likely diagnosis. Platelet transfusion requirements of the twins lasted for 7 weeks. Transfusion of HLA-matched platelet concentrates was more efficacious to manage thrombocytopaenia compared with platelet concentrates from random donors. Platelet genotyping and determination of HLA antibody specificity are needed to select compatible platelet units to expedite safe recovery from thrombocytopaenia in NAIT.

  • emergency medicine
  • resuscitation
  • surgery
  • general surgery
  • trauma
  • mediacal education

https://doi.org/10.1136/bcr-2016-218269

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    Footnotes

    • Contributors KW participated in the design of the case report, the data collection and interpretation of results. She participated in drafting and contributed to critically review the article, and approved the final manuscript. She agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved. CAA participated in the design of the report, data collection and interpretation of results. She participated in drafting and contributed to critically review the article, and approved the final version of the manuscript. She agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved. SK conceptualised the article and participated in the design of the report, data collection and interpretation of results. He participated in drafting the case report, made critical review of the article and approved the final manuscript for submission to BMJ. He agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.