Isoimmune neonatal thrombocytopenia purpura (INTP) is a disease caused by platelet destruction by maternally derived antibody. Six patients were investigated. Maternal derived platelet trans fusions in two patients resulted in posttransfusion platelet counts of greater than 85,000/μl, a normal platelet survival of 7 to 10 days, and an early discharge from the hospital. In four patients, random donor platelet transfusions administered in the first week caused a transient rise of between 7 and 30,000 platelets per μl with a return to pretransfusion levels 24 to 48 hours later, confirming the ineffectiveness of this form of treatment. Corticosteroid therapy is not effective and because of its potential toxicity should not be recommended for use in INTP. Platelet antigen was identified in the parents, and maternal sensitization was proven by the presence of platelet specific antibody. Severity of the disorder was estimated by the initial platelet count and the duration in weeks for the platelet count to rise above 100,000/μl. Lymphocytotoxicity and immune lysis, as measured by the 51Chromium release assay, did not show an obvious relationship with the severity of the disorder. In our patients, high scores in the platelet suspension immunofluo rescence test related to a more severe disorder, but a larger series would be necessary to confirm this finding.
Get full access to this article
View all access options for this article.
References
1.
Shulman NR, Aster RH, Pearson HA, et al. Immunoreactions involving platelets VI reactions of maternal isoantibodies responsible for neonatal purpura. Differentiation of a second platelet antigen system. J Clin Invest1962 ;41:1059-69.
2.
Pearson HA, Shulman NR, Marder VJ, et al. Isoimmune neonatal thrombocytopenic purpura clinical and therapeutic considerations. Blood1964;23:154-77.
3.
Shulman NR, Marder VJ, Hiller MC, et al. Platelet and leukocyte isoantigens and their antibodies. Serologic physiologic and clinical studies. Prog Hematol1962 ;4:222.
4.
Adner MM, Gilbert RF, Starobin SJ, et al. Use of 'compatible' platelet transfusions in treatment of congenital isoimmune thrombocytopenic purpura. N Engl J Med1969;280:244-85.
5.
Pearson HA, McIntosh S.Neonatal thrombocytopenia. Clin Haematol1978 ;7:111-22.
6.
von dem Borne Aeg Kr, Verheugt Fwa, Oosterhof F., et al. A simple immunofluorescence test for the detection of platelet antibodies. Br J Haematol1978;39:195-207.
7.
Cimo PL, Pisciotta AV, Desai RG, et al. Detection of drug-dependent antibodies by the 51Cr platelet lysis test: documentation of immune thrombocytopenia induced by diphenylhydantoin, diazepam, and sulfisoxazole. Am J Haematol1977;2:65-72.
8.
Sitarz AL, Driscoll JM, Wolff JAManagement of isoimmune neonatal thrombocytopenia. Am J Obstet Gynecol1976; 124:39-42.
9.
McIntosh S., O'Brien RT, Schwartz AD, et al. Neonatal isoimmune purpura response to platelet infusions. J Pediatr1973;82:1020-7.
10.
Anthony B., Krivit W.Neonatal thrombocytopenic purpura. Pediatrics1976;30:776-83.
11.
Vain ME, Bedros AATreatment of isoimmune thrombocytopenia of the newborn with transfusion of maternal platelets. Pediatrics1979;63:107-9.
12.
Von dem Borne Aeg Kr, van Leeuwen Ef, von Riesz Le, et al. Neonatal alloimmune thrombocytopenia: detection and characterization of the responsible antibodies by the platelet immunofluorescence test. Blood1981;57:649-56.
