Japanese

Title	新生児同種免疫性血小板減少症の発症予防を目的として母体への免疫グロブリン療法を行った一例
Subtitle	症例報告
Authors	山形知央1)2), 小松摩耶1), 千草義継1), 川村洋介1)3), 松坂直1), 山口綾香1), 高倉賢人1), 上田優輔1), 最上晴太1), 万代昌紀1)
Authors (kana)
Organization	1)京都大学医学部附属病院産科婦人科, 2)公立豊岡病院組合立豊岡病院産婦人科, 3)滋賀県立総合病院産婦人科
Journal	日本周産期・新生児医学会雑誌
Volume	60
Number	2
Page	271-275
Year/Month	2024 / 9
Article	報告
Publisher	日本周産期・新生児医学会
Abstract	「概要」新生児同種免疫性血小板減少症(NAIT)は母体で産生された血小板抗体によって生じる血小板減少症で, 児に頭蓋内出血をきたすこともある. 次回妊娠時にもNAITの発症リスクが存在するが有効な周産期管理指針は存在しない. 症例は38歳, 4妊2産. 第2子は出生直後に点状出血があり, 血小板数30×10 3/μLであった. 母体から抗ヒト血小板特異抗原(HPA)-4b抗体が検出され, NAITが疑われた. 第3子を妊娠し, 羊水検査で児がHPA-4a/bを保持していることが判明した. 児にNAIT発症が危惧されたことから, 妊娠30週から免疫グロブリンを1週間ごとに投与し, 妊娠39週に経腟分娩した. 児の血小板数最低値は60×10 3/μL(日齢1)であったが自然回復し, 合併症をきたさなかった. 同胞にNAITが疑われた際には, 羊水検査でHPAタイピングを行い, 免疫グロブリン療法を行うことで, 児の良好な周産期予後が得られる可能性がある.
Practice	臨床医学：外科系
Keywords	Amniocentesis, human platelet antigen, intra cranial hemorrhage, intravenous immunoglobulin, neonatal alloimmune thrombocytopenia

English

Title	A case of maternal immunoglobulin therapy to prevent the development of neonatal alloimmune thrombocytopenia
Subtitle
Authors	Tomo Yamagata1)2), Maya Komatsu1), Yoshitsugu Chigusa1), Yosuke Kawamura1)3), Sunao Matsuzaka1), Ayaka Yamaguchi1), Masahito Takakura1), Yusuke Ueda1), Haruta Mogami1), Masaki Mandai1)
Authors (kana)
Organization	1)Department of Obstetrics and Gynecology, Kyoto University Hospital, 2)Department of Obstetrics and Gynecology, Toyooka Hospital, 3)Department of Obstetrics and Gynecology, Shiga General Hospital
Journal	Journal of Japan Society of Perinatal and Neonatal Medicine
Volume	60
Number	2
Page	271-275
Year/Month	2024 / 9
Article	Report
Publisher	Japan Society of Perinatal and Neonatal Medicine
Abstract	Neonatal alloimmune thrombocytopenia (NAIT) is a rare but severe pregnancy-associated disease caused by human platelet antigen (HPA) incompatibility between the mother and fetus. The principal complication of NAIT is intracranial hemorrhage (ICH), which poses a substantial risk of perinatal mortality. Although the platelet counts of neonate tends to be lower during subsequent pregnancies following its manifestation during pregnancy with an older sibling, effective preventive perinatal management has not been established. In this report, we present the case of a 38-year-old woman, gravida 4 para 2. Her second child exhibited systemic petechial hemorrhage immediately after birth, accompanied by a platelet count of 30 * 10 3 / μ L. Anti-HPA- 4b antibodies were detected in the mother, and NAIT was suspected. During the subsequent conception with her third child, amniotic fluid analysis revealed the presence of HPA- 4 a/b in the fetus. Since there was concern that the baby might develop severe NAIT, intravenous immunoglobulin was administered every week starting at 30 weeks gestation, and the patient delivered the baby vaginally at 39 weeks gestation. The infant's platelet count was 60 * 10 3 / μ L, exhibiting spontaneous recovery with an absence of significant complications. When NAIT is suspected during pregnancy with an older sibling, HPA typing via amniocentesis and intravenous immunoglobulin therapy could emerge as promising strategies for enhancing the perinatal prognosis in subsequent pregnancies.
Practice	Clinical surgery
Keywords	Amniocentesis, human platelet antigen, intra cranial hemorrhage, intravenous immunoglobulin, neonatal alloimmune thrombocytopenia

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