A rare manifestation of neonatal alloimmune thrombocytopaenia

Abstract

Neonatal alloimmune thrombocytopaenia (NAIT) results from a fetomaternal incompatibility with maternal sensitisation against a fetal human platelet antigen (HPA) and antibodies transfer to the fetal circulation, leading to platelet destruction. The clinical presentation is variable and isolated intraocular haemorrhage is rare. We present the case of a male newborn, with intrauterine growth restriction, born at 29 weeks due to pre-eclampsia. He presented proptosis of the left eye, hyphaema and elevated intraocular pressure, with no other signs of haemorrhage. Severe thrombocytopaenia was found (27×10(9)/L). Perinatal infection and maternal thrombocytopaenia were excluded. Positive anti-HPA-1a and antihuman leucocyte antigen class I alloantibodies were found in the mother. Platelet crossmatch between the father's platelets and mother's plasma was positive. Platelet transfusions and intravenous immunoglobulin were given with favourable response. This case highlights an unusual presentation of NAIT, which should be suspected in the presence of severe thrombocytopaenia in the first 24-72 h of life.

Figure 1

Clinical presentation: left eye proptosis and haemorrhage in the anterior chamber of the eye (hyphaema).

Figure 2

Clinical presentation: left eye proptosis and haemorrhage in the anterior chamber of the eye (hyphaema).

Figure 3

Treatment and platelet count response. PT, random donor platelet transfusion; TPN, platelet transfusion from a compatible donor (HPA-1a negative); IVIg, intravenous immunoglobulin.