Gemma L Crighton1,2,3, Ri Scarborough1, Zoe K McQuilten1,4, Louise E Phillips1, Helen F Savoia3,5, Bronwyn Williams6,7, Rhonda Holdsworth2, Amanda Henry8,9, Erica M Wood1,10, Stephen A Cole5. 1. a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia. 2. b Australian Red Cross Blood Service , Melbourne , Australia. 3. c The Royal Children's Hospital , Melbourne , Australia. 4. d Australia and New Zealand Intensive Care Research Centre (ANZIC-RC) , Melbourne , Australia. 5. e The Royal Women's Hospital , Melbourne , Australia. 6. f Royal Brisbane and Women's Hospital , Brisbane , Australia. 7. g Lady Cilento Children's Hospital , Brisbane , Australia. 8. h School of Women's and Children's Health, University of New South Wales , Australia. 9. i St George Hospital , Sydney , Australia , and. 10. j Monash Medical Centre , Melbourne , Australia.
Abstract
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.
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.
Authors: Tarun Sai David Campion; J Oliver Daly; Melissa Wake; Susannah Ahern; Joanne M Said Journal: Aust N Z J Obstet Gynaecol Date: 2022-05-11 Impact factor: 1.884