Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, Division of Medical Oncology & Hematology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Transfusion. 2022 Nov;62(11):2213-2222. doi: 10.1111/trf.17144. Epub 2022 Oct 14.
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the most common cause of intracranial hemorrhage (ICH) in thrombocytopenic term infants. We investigated clinical and laboratory predictors of severe FNAIT in a tertiary care referral center.
Retrospective cohort study over a 30-year period. We defined FNAIT as recurrence of neonatal thrombocytopenia in a subsequent pregnancy; and severe outcomes as any of: (1) a birth platelet count below 20 × 10 /L; (2) ICH or (3) fetal death. We used a generalized estimating equations analysis and classification tree analysis to identify risk factors for severe FNAIT in a subsequent pregnancy.
During index pregnancies (n = 135 in 131 mothers), 71 infants (52.6%) had severe outcomes including a platelet count <20 × 10 /L (n = 45), fetal or neonatal ICH (n = 32), or fetal death (n = 4). During subsequent pregnancies (n = 72), 15 infants (20.8%) had severe outcomes including birth platelets <20 × 10 /L (n = 10), ICH (n = 2), or death (n = 3). Forty-two women (58.3%) received antenatal intravenous immune globulin (IVIG) during subsequent pregnancies. Eight mothers (n = 9 infants) had severe FNAIT outcomes despite receiving antenatal IVIG. Maternal antibodies to human platelet antigens (HPA) was the only independent predictor of severe FNAIT in a subsequent pregnancy (OR = 25.3, p = .004). Nevertheless, one of 43 infants from antibody-negative mothers had a severe outcome.
The presence of anti-HPA is highly indicative of the diagnosis of severe FNAIT; however, we observed one infant who had severe FNAIT recurrence, defined using strict clinical criteria, without a maternal antibody. Improved diagnostic and therapeutic strategies are needed to prevent severe FNAIT in high-risk mothers.
胎儿和新生儿同种免疫性血小板减少症（FNAIT）是血小板减少症足月婴儿颅内出血（ICH）的最常见原因。我们在一家三级医疗中心调查了严重 FNAIT 的临床和实验室预测因素。
这是一项为期 30 年的回顾性队列研究。我们将 FNAIT 定义为随后妊娠中新生儿血小板减少症的复发；严重结局包括以下任何一种：（1）出生时血小板计数低于 20×10 /L；（2）ICH 或（3）胎儿死亡。我们使用广义估计方程分析和分类树分析来确定随后妊娠中严重 FNAIT 的危险因素。
在指数妊娠期间（131 名母亲中的 135 名婴儿），71 名婴儿（52.6%）出现严重结局，包括血小板计数<20×10 /L（n=45）、胎儿或新生儿 ICH（n=32）或胎儿死亡（n=4）。在随后的妊娠中（n=72），15 名婴儿（20.8%）出现严重结局，包括出生时血小板计数<20×10 /L（n=10）、ICH（n=2）或死亡（n=3）。42 名妇女（58.3%）在随后的妊娠中接受了产前静脉注射免疫球蛋白（IVIG）。尽管接受了产前 IVIG，但仍有 8 名母亲（n=9 名婴儿）出现严重的 FNAIT 结局。母体人类血小板抗原（HPA）抗体是随后妊娠中严重 FNAIT 的唯一独立预测因素（OR=25.3，p=0.004）。然而，在来自抗体阴性母亲的 43 名婴儿中，有 1 名出现严重结局。
抗-HPA 的存在高度提示严重 FNAIT 的诊断；然而，我们观察到一名婴儿在没有母体抗体的情况下出现了严格的临床标准定义的严重 FNAIT 复发。需要改进诊断和治疗策略，以预防高危母亲的严重 FNAIT。
