Neonatalna trombocitopenija

master's thesis

• Title (english): Neonatal thrombocytopenia
• Author: Iva Zagorec
• Mentor: Dorotea Ninković (mentor)
• Committee member: Boris Filipović-Grčić (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Dorotea Ninković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Trombocitopenija je broj trombocita manji od 150 x 109 L. Diferencijalna dijagnoza neonatalne trombocitopenije je široka. Prema vremenu nastanka dijeli se na intrauterinu, ranu (nastala u prva 72 sata života) i na kasnu (nastala nakon prvih 72 sata života), a prema mehanizmu nastanka na onu uzrokovanu pojačanom razgradnjom ili smanjenom proizvodnjom trombocita. Uz kliničku sliku osnovna dijagnostička pretraga je krvna slika, a frakcija nezrelih trombocita pomaže u razlikovanju trombocitopenija nastalih mehanizmom pojačane razgradnje ili smanjene proizvodnje. Imune trombocitopenije nastaju zbog transplacentarnog prelaska aloantitijela (neonatalna aloimuna trombocitopenija) ili autoantitijela (autoimuna trombocitopenija) iz majčine cirkulacije u fetalnu. Autoimune trombocitopenije se liječe primjenom intravenskih imunoglobulina i kortikosteroida. Neonatalna aloimuna trombocitopenija najčešći je uzrok rane neonatalne trombocitopenije kod terminske novorođenčadi. Do nastanka bolesti dolazi zbog inkompatibilnosti u trombocitnim antigenima kod majke i novorođenčeta (fetusa), posljedičnog stvaranja aloantitijela, transplacentarnog prelaska antitijela i destrukcije fetalnih trombocita. Novorođenčad najčešće ima simptome blagog krvarenja kao što su petehije i hematomi, ali u literaturi je opisana pojava i ozbiljnijih ekstrakranijalnih krvarenja. Intrakranijalno krvarenje najopasnija je prezentacija bolesti. Zlatnim standardom dijagnostike smatra se metoda MAIPA koja omogućuje detekciju antigena. Za točnu potvrdu dijagnoze uz detekciju antigena potrebna je i HPA genotipizacija majke, oca i novorođenčeta. Antenatalno liječenje se provodi intravenskim imunoglobulinima, a postnatalno liječenje se provodi transfuzijama trombocita. Trenutno ne postoji probir populacije, ali cilj bi osim detekcije HPA antitijela trebala biti i genotipizacija, a posebno za HLA-DRB3*0101 antigen zbog utvrđene snažne povezanosti između njega i proizvodnje visokog titra protutijela. Klinička važnost NAIT-a očituje se u pravovremenom prepoznavanju i liječenju kako bi se spriječile komplikacije bolesti.

Abstract (english)

Thrombocytopenia is a platelet count less than 150 x 109 L. The differential diagnosis of neonatal thrombocytopenia is broad. By the time of occurrence, it is divided into intrauterine, early (occurring in the first 72 hours of life) and late (occurring after the first 72 hours of life), and by the mechanism into caused by increased destruction or reduced production. In addition to the clinical status, the basic diagnostic test is a blood count. The immature platelet fraction helps distinguishing thrombocytopenia caused by increased destruction or reduced production. Immune thrombocytopenia is caused by the transplacental transfer of alloantibodies (neonatal alloimmune thrombocytopenia) or autoantibodies (autoimmune thrombocytopenia) from maternal to fetal circulation. Autoimmune thrombocytopenia is treated with intravenous immunoglobulins alone or in combination with corticosteroids. Neonatal alloimmune thrombocytopenia is the most common cause of early neonatal thrombocytopenia in term newborns. The disease occurs due to incompatibility in platelet antigens in the mother and newborn (fetus), resulting in the formation of alloantibodies, transplacental transfer of antibodies and destruction of fetal platelets. Most often newborns have mild bleeding symptoms such as petechiae and hematomas, but cases of more serious extracranial bleeding are also described. Intracranial bleeding is the most dangerous presentation of the disease. The gold standard for diagnostics is the MAIPA method, which enables the detection of antigens. In addition to antigen detection, HPA genotyping of the mother, father and newborn is also required to confirm the diagnosis. Antenatal treatment are intravenous immunoglobulins and postnatal platelet transfusions. There is currently no population screening, but the aim, in addition to the detection of HPA antibodies, should be genotyping, especially for the HLA-DRB3*0101 antigen due to it's established strong association with production of high concentration of antibodies. The clinical importance of NAIT is manifested in timely recognition and treatment to prevent complications of the disease.

• Keywords: HPA antitijela; novorođenče; transfuzija; trombocitopenija
• Keywords (english): HPA antibodies; neonatus; thrombocytopenia; transfusion
• Language: croatian
• URN:NBN: urn:nbn:hr:105:955214
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-11-02 12:34:07