The battle against neonatal alloimmune thrombocytopenia: a success story at institute of obstetrics and gynecology, Egmore

Abstract

Neonatal alloimmune thrombocytopenia (NAIT) is a rare hematological disorder that causes early onset isolated thrombocytopenia in neonates without any other underlying condition. NAIT occurs when maternal immunoglobin G is formed against the fetal platelets as it contains a paternal antigen, this results in thrombocytopenia in the fetus by two mechanisms, namely clearance of the antibody bound platelets and direct suppression of megakarypoiesis. Mrs X, a 28-year-old G2P1L0, hailing from a suburban town in Tamil Nadu at 18 weeks of gestation was referred by the Department of Paediatric Hematology of Institute of Child Health and Hospital for Child with history of NAIT in the previous baby. The full term boy baby had succumbed to intracranial hemorrhage involving ventricle and basal ganglia on Day 21 of life. Blood sample from both parents as well as the baby were sent to National Institute of Immunohaematology for human platelet antigen genotyping to confirm the diagnosis of NAIT. With accordance to the Severity based approach for prenatal management of NAIT by American College of Obstetricians and Gynecologists, the mother was started on intravenous immunoglobin at 20 weeks of gestation at the rate of 0.5 g/kg/week. Relentless effort put in by a team of obstetricians, neonatologists, hematologists, geneticist and many more paved ways to the successful outcome of this case report.