Alloimmune thrombocytopenia is a very serious fetal disorder caused by platelet-antigen incompatibility between the mother and fetus. The University of Pittsburgh School of Medicine states that neonatal alloimmune thrombocytopenia cases are usually discovered after the birth of the child, with babies being asymptomatic if mildly affected. Alloimmune thrombocytopenia can cause severe thrombocytopenia, leading to intracranial hemorrhage before or at birth. Babies who are severely affected show the presence of petechiae (red dots on skin of the scalp) or a cephalohematoma (collection of blood under the skin) at birth. Alloimmune thrombocytopenia can be treated during the pregnancy of the mother or quite effectively after the birth of the baby.
Intravenous Immunoglobulin (IVIG)1`
Intravenous immunoglobulin, also called intravenous gamma globulin is a blood product derived from the blood of many donors. The active ingredient is gamma globulin (IgG), according to the Hospital for Special Surgery. Intravenous immunoglobulin (IVIG) therapy can be done either while the baby is still in utero or immediately after the baby is born. This is the most common treatment for alloimmune thrombocytopenia. Infusions can begin at 20 weeks of pregnancy through the birth of the baby, improving the fetal platelet count and preventing intracranial hemorrhage.
Corticosteroid Salvage
If, after giving intravenous immunoglobulin treatments to the pregnant mother, no increase in platelet count is observed, then corticosteroid salvage (prednisone, 60 mg/day) can be administered to the mother to try to increase platelet count in the fetus, according to the book "Blood: Principles and Practice of Hemotology" by Robert I. Handin, Samuel E. Lux and Thomas P. Stossel.
Transfusion
Transfusion of compatible platelets from a donor to the baby after she is born is a successful treatment for alloimmune thrombocytopenia. Antigen-negative platelets are given to the baby in the first days of life. If there is a delay in transfusing the platelets to the baby within 24 to 48 hours, it puts her at risk for complications relating to alloimmune thrombocytopenia, according to the Auckland District Health Board.
Prognosis
With advances in fetal and transfusion medicine, the prognosis for alloimmune thrombocytopenia has improved. However, in the book "Alloimmune Disorders of Pregnancy" by Andrew Gordon Hadley and Peter Soothill, the question of the need for antenatal screening has been raised. Screening can happen, but a better understanding of which methods are best at predicting which fetuses of alliommunized mothers are most at risk must be accomplished first.
Side Effects
Intravenous gamma globulin commonly has the side effects of nausea and headache and risk of infection at the transfusion site. The administration of corticosteroids can also cause side effects if taken long-term like weight gain, acne, mood swings, and stomach ulcers. Since corticosteroid salvage is only a one time treatment, the side effects are minimized. With transfusion of antigen-negative platelets, there are no known side-effects.
References
- Hospital for Special Surgery: Guidelines for Safe Use of IVIG (Intravenous Immunoglobulin)
- "Blood: Principles and Practice of Hemotology;" Robert I. Handin, Samuel E. Lux, Thomas P. Stossel; 2003
- Auckland District Health Board: Neonatal Alloimmune Thrombocytopenia
