Alloimmune neonatal thrombocytopenic purpura
Introduction
Introduction to allogeneic neonatal thrombocytopenic purpura The same type of immunological neonatal thrombocytopenic purpura (neonatalalloimmunethrombocytopeni, NAT) is a type of congenital thrombocytopenic purpura, which is characterized by asymptomatic at birth, normal platelets, a few hours after birth, scattered in the purpura, severe thrombocytopenia Internal bleeding. basic knowledge The proportion of illness: 0.003% Susceptible population: newborn Mode of infection: non-infectious Complications: intracranial hemorrhage multiple intracranial hematoma
Cause
Immune neonatal thrombocytopenic purpura
Causes:
The cause of this disease is that pregnant women's autoantibodies pass through the placenta, leading to neonatal thrombocytopenia. About 50% of infants born to pregnant women with ITP are accompanied by thrombocytopenic purpura, and the incidence of neonates is higher during the disease. There are also normal pregnant women with platelet counts and 20% of newborns with thrombocytopenia. The common antigen associated with this disease is PLA1, others such as PLF2a, BaK9.
Pathogenesis:
The fetal platelets have specific antigens from the father, such as PLA, and the mother does not have this antigen. The pregnant mother produces antibodies to the fetal platelet antigen, and then enters the fetal blood through the placenta to destroy the platelets, because 98% of the population has platelets. PLA1, so this disease is rare, the antibody of platelet KO system is mainly IgM type, can not pass the placenta, so it will not occur.
Prevention
Immune neonatal thrombocytopenic purpura prevention
If the mother platelet PLA1 is found to be positive, cesarean section can be performed before the expected date of delivery or at the time of delivery to avoid fetal injury and bleeding in the uterus and the birth canal. If the prenatal ultrasound confirms that the fetus has intracranial hemorrhage, it should be given to the mother immediately. Intravenous immunoglobulin 0.4mg / (kg · d), until delivery, the majority of fetal platelet count can be increased.
Complication
Allogeneic neonatal thrombocytopenic purpura complications Complications intracranial hemorrhage multiple intracranial hematoma
In severe cases, intracranial hemorrhage can be complicated and life-threatening, so timely treatment should be discovered as soon as possible.
Symptom
Allogeneic neonatal thrombocytopenic purpura symptoms common symptoms thrombocytopenic intracranial hemorrhage jaundice
The main clinical feature is that the number of platelets at birth is high or normal, and acute thrombocytopenia and hemorrhagic symptoms appear only a few hours after birth. It can be seen that the whole body is scattered in the purpura and purple spots, and even in severe cases, intracranial hemorrhage can occur, and the first week after delivery can also be The presence of jaundice, the course of the disease is short, and generally does not require special treatment.
Diagnosis can be based on clinical performance and laboratory tests.
Examine
Examination of thrombocytopenic purpura in allogeneic neonates
1. Thrombocytopenia, varying degrees, often below 30 × 109 / L, occasionally less than 10 × 109 / L, the number of platelets in individual children may not decrease, the number of bone marrow megakaryocytes is normal or decreased, white blood cells are normal, after bleeding There is an increase in the number of anemia and reticulocytes, and an increase in indirect bilirubin.
2. The antibodies to platelets in children can be found in the serum of mothers of children with homology.
Diagnosis
Diagnosis and diagnosis of thrombocytopenic purpura in allogeneic neonates
The same family of immune thrombocytopenic purpura should be differentiated from neonatal traumatic hematoma. The former can have no bleeding symptoms at birth, but a few hours after delivery, the whole body can be seen in the purpura and purple spots, which helps to distinguish the disease from the hematoma.
