Neonatal Thrombocytopenia: Differing Characteristics of NAIT Versus Non-NAIT

Abstract

While neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe neonatal thrombocytopenia good clinical predictors are lacking. We analyzed cases of neonatal thrombocytopenia in Schneider Children’s Medical Center of Israel to pinpoint qualifiers of NAIT (NAIT+) in comparison to non-NAIT (NAIT−) thrombocytopenia. Patient and maternal data were retrospectively collected on all thrombocytopenic newborns undergoing a workup for NAIT in our tertiary center between 2001 and 2016. Among 26 thrombocytopenic neonates, the mean nadir in NAIT+ patients (25×109/L) was significantly lower than NAIT− patients (64×109/L) (P<0.001). 61.5% of NAIT+ infants required treatment compared with 23% of non-NAIT (P=0.015). NAIT+ patients also required more therapeutic modalities than infants with NAIT− thrombocytopenia. Human platelet antigen (HPA)-1a and HPA-5b alloantibodies most frequently caused NAIT. In summary, thrombocytopenia in NAIT+ was significantly more severe compared with NAIT− and more likely to require treatment. In addition, despite the varied ethnic population in Israel, the HPA alloantibodies found in our population were most similar to those common in Western countries. In the absence of rigorous prenatal screening options, we suggest platelet counts below 40 to 50×109/L in a healthy newborn be considered most suggestive for NAIT and warrant urgent NAIT-specific analysis.