Isoimmune thrombocytopenia: Coordinated management of mother and infant

Thrombocytopenia at birth is associated with significant mortality and morbidity. The authors have recently managed 2 siblings with isoimmune thrombocytopenia (IITP). The first, born in 1976, had bilateral cephalhematoma, hyperbilirubinemia, and thrombocytopenia. Platelet count remained low after transfusion of platelet concentrate from a random donor, but rose considerably after transfusion of maternal platelets. The mother was platelet antigen (PLA1) negative and had a high platelet antibody titer. The second child was asymptomatic but developed thrombocytopenia. Management included corticosteroid therapy, exchange transfusion, maternal platelet transfusion, and, later, transfusion of compatible platelets from a maternal uncle. Neither of the babies had purpura. Isoimmune thrombocytopenia in a first-born child is difficult to anticipate. In the subsequent pregnancies after an affected child, close relatives of the mother may be tested for PLA1. Platelet concentrate from a PLA1 negative donor should be available for transfusion at the time of delivery. Blood from the PLA1 negative donor may be utilized for early exchange transfusion.