Trombocitopenia neonatal imune - revisão
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v29.i1.17587Palavras-chave:
trombocitopenia aloimune, trombocitopenia autoimune, recém-nascidoResumo
Introdução: Trombocitopenia é a alteração hematológica mais frequente no período neonatal, sendo trombocitopenia imune a principal causa de trombocitopenia moderada a grave em recém-nascidos aparentemente saudáveis. O desenvolvimento de trombocitopenia imune no feto ou no recém-nascido pode dever-se à passagem transplacentária de anticorpos plaquetários maternos, nomeadamente aloanticorpos dirigidos a antigénios paternos herdados pelo feto (aloimune) ou autoanticorpos sintetizados por patologia autoimune materna (autoimune).
Objetivos: Rever a literatura pulicada até à data sobre o tema, incluindo os últimos avanços sobre patogénese, diagnóstico, tratamento e prevenção de trombocitopenia imune em recém-nascidos.
Resultados: Trombocitopenia neonatal aloimune é a causa mais comum de trombocitopenia grave e hemorragia intracraniana em recém-nascidos de termo. A apresentação clínica varia entre trombocitopenia ligeira isolada e hemorragia intracraniana letal. Dado que o rastreio pré-natal não é efetuado por rotina, a maioria dos casos são diagnosticados no primeiro filho. Apesar de intensa investigação, não existe atualmente uma estratégia consensual de prevenção e tratamento da condição. Deve existir suspeita de trombocitopenia neonatal autoimune em presença de história materna sugestiva ou trombocitopenia materna. Púrpura trombocitopénica imune materna não comporta um risco elevado de hemorragia perinatal, embora possa originar trombocitopenia –na maioria dos casos, ligeira a moderada − no recém-nascido. A apresentação clínica varia entre ausência de sintomas a presença de sinais mucocutâneos de trombocitopenia e pode persistir durante semanas a meses, requerendo monitorização a longo prazo.
Conclusões: A trombocitopenia aloimune fetal e neonatal é causa de doença grave no feto ou no recém-nascido afetado. Dada a inexistência de rastreio pré-natal de rotina, é efectuada a revisão das estratégias propostas atualmente para as gestações de risco, assim como a discussão da investigação mais recente e das terapias em desenvolvimento, cujo objectivo é melhorar o diagnóstico, tratamento e prevenção dessa doença. A trombocitopenia neonatal autoimune pode levar a baixa contagem de plaquetas persistente, sendo necessário um controlo regular.
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