27-year-old pregnant woman, blood group A positive, with a personal history of meningitis at the age of 3, curettage for molar pregnancy (G1P0A1) in her first pregnancy in 2005 and smoker of 10-20 cigarettes/day. No previous history of transfusions.
In the ultrasound performed at 35 weeks' gestation, bilateral foetal hydrocephalus and oligohydramnios were detected, so a caesarean section was scheduled for 36 weeks' gestation. The previous analytical study showed a positive serology (IgM) for Parvovirus B19. Examination of the newborn after caesarean section revealed a good general condition, with an Apgar test of 8 and 9 points in the first and fifth minute, respectively, small haematomas on the left shoulder and buttock, macrocephaly with anterior fontanel under tension and prominence of the cephalic veins. The haemogram showed severe tombocytopenia (9 x 109/L). Given the clinical suspicion of NAFLD, an aliquot of irradiated apheresis platelet concentrate of unknown HPA-1a phenotype was transfused and treatment was started with intravenous immunoglobulins (IVIG) at a dose of 1 g/kg x 2 days, with a very good response (platelets > 100 x 109/L, which were maintained throughout the hospital stay). An immunohaematological study was requested from the Blood Transfusion Centre of Navarra, as well as a search for platelets from a negative HPA-1a donor.
Brain ultrasound showed severe hydrocephalus secondary to intraventricular haemorrhage, which required the placement of an external shunt catheter, through which pressurised haemorrhagic cerebrospinal fluid was collected. Subsequent evolution was torpid, with ventriculitis and seizures, which required treatment with antibiotic therapy and phenobarbital, respectively, and implantation of a ventriculoperitoneal shunt valve. During his admission, an aliquot of leucodepleted and irradiated red blood cell concentrate was transfused.
The immunohaematological study performed at the Centro de Transfusión Sanguínea de Navarra confirmed the negative HPA-1a phenotype in the mother and positive in the newborn, as well as the presence of antibodies with anti-HPA-1a specificity in the maternal serum and in the newborn.