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Blood, 1 August 2007, Vol. 110, No. 3, pp. 833-839.
Prepublished online as a Blood First Edition Paper on April 11, 2007; DOI 10.1182/blood-2006-08-040121.
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CLINICAL TRIALS AND OBSERVATIONS
A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia
Jens Kjeldsen-Kragh1,4,
Mette Kjær Killie5,8,
Geir Tomter1,
Elzbieta Golebiowska1,
Ingrid Randen1,4,
Reidun Hauge1,
Berit Aune6,9,
Pål Øian6,9,
Lauritz B. Dahl7,9,
Jouko Pirhonen2,4,
Rolf Lindeman3,4,
Henrik Husby10,
Guttorm Haugen10,12,
Morten Grønn11,
Bjørn Skogen5,8, and
Anne Husebekk5,8
Departments of1 Immunology and Transfusion Medicine
2 Obstetrics and Gynecology, and
3 Pediatrics, Ullevål University Hospital, Oslo;
4 Faculty Division Ullevål University Hospital, University of Oslo, Oslo;
Departments of5 Immunology and Transfusion Medicine
6 Obstetrics and Gynecology, and
7 Pediatrics, University Hospital of North Norway, Tromsø; Institutes of
8 Medical Biology and
9 Clinical Medicine, University of Tromsø, Tromsø;
Departments of10 Obstetrics and Gynecology and
11 Pediatrics, Rikshospitalet-Radiumhospitalet Medical Center, Oslo;
12 Faculty Division Rikshospitalet, University of Oslo, Oslo, Norway
The study's objective was to identify HPA 1a–negative women and to offer them an intervention program aimed to reduce morbidity and mortality of neonatal alloimmune thrombocytopenia (NAIT). HPA 1 typing was performed in 100 448 pregnant women. The HPA 1a–negative women were screened for anti–HPA 1a. In immunized women, delivery was performed by Cesarean section 2 to 4 weeks prior to term, with platelets from HPA 1a–negative donors reserved for immediate transfusion if petechiae were present and/or if platelet count was less than 35 x 109/L. Of the women screened, 2.1% were HPA 1a negative, and anti–HPA 1a was detected in 10.6% of these. One hundred seventy pregnancies were managed according to the intervention program, resulting in 161 HPA 1a–positive children. Of these, 55 had severe thrombocytopenia (< 50 x 109/L), including 2 with intracranial hemorrhage (ICH). One woman with a twin pregnancy missed the follow-up and had one stillborn and one severely thrombocytopenic live child. In 15 previous prospective studies (136 814 women) there were 51 cases of severe NAIT (3 intrauterine deaths and 7 with ICH). Acknowledging the limitation of comparing with historic controls, implementation of our screening and intervention program seemed to reduce the number of cases of severe NAIT-related complications from 10 of 51 to 3 of 57.
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