Neonatal Alloimmune Thrombocytopenia

Neonatal Alloimmune Thrombocytopenia is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

Neonatal alloimmune thrombocytopenia (NAIT) is one of the major causes of severe thrombocytopenia in the newborn.

  • Analogous to ABO/Rh incompatibility but involves platelets instead of RBCs
  • Presents with bleeding complications including petechiae, bruising, mucosal bleeding, and/or intracranial hemorrhage (ICH) that can occur in utero

Epidemiology

  • Incidence is ∼1:1,000 to 1:2,000 live births.

General Prevention

The disease cannot be prevented.

Pathophysiology

Antibody-mediated platelet destruction

Etiology

Maternal IgG antibodies (Ab), directed against paternally inherited platelet-specific antigens in the fetus, cross the placenta, enter the fetal circulation, and attack fetal platelets.

  • HPA-1a (formerly PLA-1) incompatibility is by far the most common cause of NAIT in those of Caucasian ancestry, accounting for ∼75% of cases. The disease happens when the mother is HPA-1a negative (HPA 1b/1b) and father is HPA-1a positive (HPA 1a/1a or 1a/1b). If the fetus inherits HPA-1a from father, maternal exposure to HPA-1a–positive fetal platelets during pregnancy causes mother to generate anti–HPA-1a IgG Ab. Anti–HPA-1a Ab crosses the placenta and causes platelet destruction.
  • Other common antigens implicated in NAIT include HPA-2, HPA-3, HPA-5, HPA-9, and HPA-15.
  • HPA-4 incompatibility accounts for the majority of cases in Asian populations.
  • At least 23 other low-frequency antigens have been reported in a small fraction of cases.
  • HPA-1a–negative mothers who are HLA-DRB3*0101 positive are far more likely to develop Ab than those who are DRB3 negative.
  • The role of HLA platelet antigens in NAIT is unclear.

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Citation

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TY - ELEC T1 - Neonatal Alloimmune Thrombocytopenia ID - 14090 Y1 - 2015 PB - Select 5-Minute Pediatrics Topics UR - https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14090/all/Neonatal_Alloimmune_Thrombocytopenia ER -