Amélia Moreira1, Maria José Vale1, Joana Neves1, Clara Paz Dias1
1 S. Pediatria, Unidade de Cuidados Intensivos Neonatais (UCIN), C H Alto Ave, Guimarães
RESUMO
Introdução: A redução do número de plaquetas nas primeiras horas de vida deve-se frequentemente a factores maternos ou eventos perinatais. A trombocitopenia aloimune, embora subdiagnosticada, é a causa mais frequente de trombocitopenia severa no recém-nascido de termo saudável e resulta da destruição imunomediada das plaquetas fetais/neonatais por aloanticorpos maternos.
Caso clínico: Apresenta-se o caso de um recém-nascido com trombocitopenia aloimune, com clínica típica e evolução favorável, sublinhando-se o impacto positivo de um elevado índice de suspeição e do tratamento empírico com plaquetas HPA-1a negativas.
Conclusão: O diagnóstico atempado desta entidade permite uma orientação terapêutica eficaz, baseada na administração de plaquetas compatíveis, prevenindo eventuais complicações, nomeadamente, a hemorragia intracraniana. Possibilita ainda o planeamento da vigilância em gestações futuras do casal e o tratamento pré-natal.
]]> Palavras-chave: plaquetas HPA-1a negativas, recém-nascido de termo, trombocitopenia aloimune.
Severe neonatal thrombocytopenia
ABSTRACT
Introduction: Thrombocytopenia in the first hours of life is generally due to maternal factors or perinatal events. Alloimune thrombocytopenia, although underdiagnosed, is the most frequent type of severe thrombocytopenia in a term and otherwise healthy newborn, resulting from an immune mediated destruction of foetal/neonatal platelets by maternal alloantibodies.
Case report: We present the case of a newborn with alloimune thrombocytopenia, a typical clinical presentation and good outcome, highlighting the positive impact in the prognosis of a high index of suspicion and of empirical treatment with HPA-1a negative platelets.
Conclusion: An early diagnosis of this entity allows effective treatment with the infusion of compatible platelets, preventing eventual complications, namely intracranial haemorrhage. Also guides the monitoring of future pregnancies and antenatal treatment.
Keywords: alloimune thrombocytopenia, HPA-1a negative platelets, term newborn.
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Amélia José Faria Moreira
]]> UCIN - Serviço de Pediatria, CHAA – GuimarãesRua dos Cutileiros – Creixomil
4835-044 Guimarães
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