Intrauterin use of hyperconcentrated platelet concentrates collected with Trima Accel in a case of neonatal alloimmune thrombocytopenia

Aims: Due to the threat of serious or fatal bleedings fetuses with neonatal alloimmune thrombocytopenia (NAIT) may need intrauterine PLT transfusions. To prevent a volume overload or a AB0 minor incompatibility, standard PLT concentrates need to be washed to increase the PLT concentration and to reduce the plasma content. Hyperconcentrated single donor platelet concentrates (HCPs) are a therapeutic alternative. We report the first case of NAIT successfully treated with HCPs collected with the Trima Accel^TM (TA). Case report: A 31-year-old woman with a history of NAIT in the preceding pregnancy underwent cordocentesis three times during her third pregnancy (30^th, 31^st and 32^nd weeks of gestation). NAIT was confirmed by marked fetal thrombocytopenia, a maternal anti-HPA–1a-IgG (titer 1: 128) and the appropriate HPA-genotype of the fetus and the parents. On each cordocentesis a distinct volume of a HPA–1a-negative HCP with a PLT concentration of 3×10⁶ PLTs per µL was transfused resulting in high CCIs after two minutes. The HCPs were transfused within 10 hours after collection. One day after the last cordocentesis, a Caesarean section was performed. The newborn did not show any bleeding signs and the PLT count remained on normal levels and no further PLT transfusions were needed. Conclusion: HCP collected with TA are a useful alternative to washed standard PLT concentrates without the need for further manipulation of the product after collection. However, further in-vitro and in-vivo studies are needed to make definite recommendations for the shelf-life of these HCP.

NAIT - Trima Accel - hyperconcentrated platelet concentrates