Hemorragia intracraneal por trombopenia neonatal aloinmune. Comunicación de un caso y revisión / Intracraneal hemorrhage caused by neonatal alloinmune thrombocytopenia. Report of a case and review
Rev. neurol. (Ed. impr.)
; 43(2): 84-87, 16 jul., 2006. ilus
Article
in Es
| IBECS
| ID: ibc-048293
Responsible library:
ES1.1
Localization: ES1.1 - BNCS
RESUMEN
Introducción. La trombopenia neonatal aloinmune (TNA)se debe al paso de aloanticuerpos maternos dirigidos contra losantígenos plaquetarios fetales heredados del padre. En un 15-30%de los casos se produce hemorragia cerebromeníngea que puedeconducir a secuelas neurológicas importantes. Caso clínico. Sedescribe un caso de TNA en un recién nacido con antecedentes dedos hermanos fallecidos por el mismo motivo. A las 31 semanas sedetecta por ecografía hemorragia cerebral intraparenquimatosa yse efectúa parto por cesárea. Apgar de 8 y 9, no precisa maniobrasde reanimación. El examen físico revelaba desde el nacimientopúrpura cutánea generalizada y palidez, y el hemograma, una plaquetopeniagrave de 6.000/mm3; el recuento de la madre es normal,hemoglobina de 8,8 g/dL y hematocrito de 26,1%, sin otrasalteraciones biológicas destacables. En la sangre materna se detectaronaloanticuerpos de especificidad anti-HPA-1a; el padre eshomocigoto para 1a/1a, y la madre, para 1b/1b. Recibió transfusionesde plaquetas, así como inmunoglobulina endovenosa y corticoterapia,y evoluciona favorablemente. Conclusiones. La hemorragiaintracraneal parenquimatosa es una patología neonatal pocofrecuente, lo que obliga siempre a descartar un trastorno congénitode la coagulación, especialmente una TNA por su frecuencia ypotencial gravedad; en ocasiones puede tener una buena evoluciónneurológica. Es fundamental su prevención y tratamiento precoz yla realización de estudios de imagen, aun en ausencia de clínicaneurológica
ABSTRACT
Introduction. Neonatal alloimmune thrombocytopenia (NAT) is due to the transplacental transfer of circulatingmaternal alloantibodies developed against fetal platelet antigens inherited from the father. Intracranial hemorrhage occurs in15-30% of the cases, and very important neurological sequelaes can be due to it. Case report. We present the clinical andimmunohematologic findings of a case of severe NAT that had two siblings who died by this illness. In the 31st week ofgestation an intracranial hemorrhage is detected by echography, the birth was by caesarean section. Apgar score of 8 and 9,it wasnt necessary reanimation procedures. Cutaneous purpura and pallor were presented since birth. Neonatal completeblood count showed a platelet count of 6,000/mm3 (whereas maternal blood count was normal), haemoglobin of 8.8 g/dL andhematocrit of 26.1%, without other biological alterations. In maternal blood alloantibodies antiHPA-1a were detected, beingthe father homozigous for 1a/1a and the mother homozigous for 1b/1b. The patient was treated with transfusions, endovenousgammaglobulin and corticosteroids and his condition improved. Conclusions. Intraparenchymatous hemorrhage is an uncommonpathology in neonates, but when this occurs its obligated to rule out a coagulation inherited illness, NTA especially,because of its prevalence and potentially serious neurological sequelaes, sometimes having a good neurological development.Prevention, early treatment and neuroimaging studies should be done in all newborn babies with alloimmune thrombocytopeniaeven when no neurological clinic is seen
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Collection:
06-national
/
ES
Database:
IBECS
Main subject:
Thrombocytopenia
/
Intracranial Hemorrhages
/
Fetal Diseases
Type of study:
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Newborn
/
Pregnancy
Language:
Es
Journal:
Rev. neurol. (Ed. impr.)
Year:
2006
Document type:
Article