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Abstract(s)
A trombocitopenia neonatal aloimune (TNAI) é uma condição rara mas potencialmente grave, com uma incidência de aproximadamente 1:1000 nados vivos, incidência esta que não inclui abortos e casos assintomáticos que escapam ao diagnóstico, estando provavelmente subdiagnosticada. Resulta da destruição das plaquetas do feto e/ou recém-nascido induzida por anticorpos maternos dirigidos contra antigénios plaquetários fetais. É a causa mais comum de trombocitopenia isolada e grave associada a hemorragias no período neonatal. Cerca de 10% dos casos de TNAI condicionam uma hemorragia intracerebral (HIC) sendo que 90% dos casos, ocorrem in útero . Ao contrário da doença hemolítica do recém-nascido por incompatibilidade do sistema Rh, a TNAI pode manifestar-se de forma grave mesmo a primeira gestação pelo que alguns autores debatem a importância do rastreio durante a gravidez. Descreve-se o caso de um bebé nascido por cesariana às 36semanas + 1dia, por suspeita pré-natal de hemorragia intracraniana. Ao nascimento documenta-se uma trombocitopenia grave que posteriormente se veio a confirmar ser de causa aloimune, por incompatibilidade do antigénio HPA1a (o antigénio que mais frequentemente causa TNAI), associada a hemorragia intracraniana direita de dimensões consideráveis com ventriculomegália.
Neonatal alloimmune thrombocytopenia (TNAI) is a rare but potentially serious condition, affecting approximately 1:1000 newborn babies. This does not include abortions and asymptomatic cases that escape diagnostic, reason for being probably underdiagnosed. It causes the destruction of the fetus and/or newborn platelets by maternal antibodies directed against the fetus platelets antigens. It is the most common cause of isolated and serious thrombocytopenia associated to bleeding in the neonatal period. Around 10% of the cases of TNAI result in intracerebral haemorrhage, in these 90% occur inside the uterus. Unlike the hemolytic disease of the newborn through Rh system incompatibility, TNAI can manifest in a serious way in the first trimester, reason why some authors argue the importance of being screened during pregnancy. In this paper we describe the case of a baby born through caesarean delivery at 36 weeks plus 1 day of age, because it was suspected of having intracranial haemorrhage. It was found to be having a serious trombocitopenia that was later confirmed of being caused by the incompatibility of the HPA1a antigen (the most common antigen in TNAI), associated with right intracranial bleeding of considerable dimension with ventriculomegaly.
Neonatal alloimmune thrombocytopenia (TNAI) is a rare but potentially serious condition, affecting approximately 1:1000 newborn babies. This does not include abortions and asymptomatic cases that escape diagnostic, reason for being probably underdiagnosed. It causes the destruction of the fetus and/or newborn platelets by maternal antibodies directed against the fetus platelets antigens. It is the most common cause of isolated and serious thrombocytopenia associated to bleeding in the neonatal period. Around 10% of the cases of TNAI result in intracerebral haemorrhage, in these 90% occur inside the uterus. Unlike the hemolytic disease of the newborn through Rh system incompatibility, TNAI can manifest in a serious way in the first trimester, reason why some authors argue the importance of being screened during pregnancy. In this paper we describe the case of a baby born through caesarean delivery at 36 weeks plus 1 day of age, because it was suspected of having intracranial haemorrhage. It was found to be having a serious trombocitopenia that was later confirmed of being caused by the incompatibility of the HPA1a antigen (the most common antigen in TNAI), associated with right intracranial bleeding of considerable dimension with ventriculomegaly.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Keywords
Trombocitopenia neonatal aloimune HPA1a Hemorragia intracraniana Transfusão plaquetária Pediatria