Risk factors for severe neonatal thrombocytopenia in cases of maternal immune thrombocytopenia

Burden of immune thrombocytopenia (ITP): Special considerations for refractory ITP

It is known that patients with immune thrombocytopenia (ITP) have fatigue and impairment of health-related quality of life (HRQoL). However, it is hypothesized that patients with refractory ITP have additional burdens that should be considered. Specifically, fatigue is more pronounced in patients with refractory disease, there are additional side effects from second- and third-line treatments, additional anxiety about the long-term course of the disease, impairment in HRQoL resulting from heavy menstrual bleeding and concerns related to family planning. The burden of disease, therefore, should be carefully assessed and considered in these patients. However, researchers have utilized numerous tools for evaluating HRQoL and fatigue, making comparison of data across studies challenging. There is a need to standardize assessment using either disease-specific or generic instruments that can be easily implemented in routine clinical practice. Additionally, whether treatment of low platelet count and bleeding symptoms will have a positive influence on HRQoL remains to be seen and published evidence is conflicting. Nevertheless, improvement of HRQoL is a major treatment goal for both patients and physicians and should be especially considered when treating patients with refractory ITP.

Effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia

We aimed to determine the effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia (ITP). This single-center, retrospective study included 41 mothers with ITP and their 65 infants born by vaginal delivery (VD, n = 30) and cesarean section (CS, n = 35) between January 1997 and March 2022. The median difference in platelet counts from day 0 to day 2 (ΔPlt [D 0-2]) was significantly lower in the VD group (- 39 × 10⁹/L, interquartile range [IQR]: - 47 to - 24 × 10⁹/L) than the CS group (15 × 10⁹/L, IQR: - 6.5 to 33 × 10⁹/L) (p < 0.001). The median ΔPlt (D 0-5) was significantly lower in the VD group (- 55 × 10⁹/L, IQR: - 85 to - 31 × 10⁹/L) than the CS group (33 × 10⁹/L, IQR: 1-69 × 10⁹/L) (p < 0.001). Multivariate analysis also showed a significant association of delivery mode with ΔPlt (D 0-2) and ΔPlt (D 0-5) (both p < 0.001). VD neonates with platelet counts ≥ 100 × 10⁹/L at birth were significantly more likely than CS neonates to develop thrombocytopenia < 100 × 10⁹/L at nadir (1/26 vs. 6/25) (p = 0.0496). Our findings indicate that mode of delivery is a useful predictor of postnatal platelet count dynamics in neonates born to mothers with ITP.

Severe Neonatal Alloimmune Thrombocytopenia in a Multiparous Female With No Prior History

Neonatal Alloimmune Thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in newborns. It is also the most common cause of morbidity and mortality in full-term infants that present with severe thrombocytopenia, given its association with intracranial hemorrhage (ICH). NAIT can present in many ways depending on the severity of platelet destruction. The patient's presentation can range from asymptomatic or can include more serious symptoms such as petechial rash and ICH. Due to potentially fatal outcomes of undiagnosed severe NAIT, it is imperative that patients are identified, diagnosed, and treated in a timely and efficient manner. We report a case of NAIT in a newborn male infant who initially was asymptomatic and eventually developed a petechial rash that encompassed the torso and groin as the only signs of disease. Given the importance of the timely diagnosis and treatment of NAIT and its potentially fatal outcomes, the aim of this case report is to help clinicians recognize the presentation of NAIT and the steps in treating it.