Thesis Thijs de Vos
On 13 April 2023 Thijs de Vos defended his thesis 'Fetal and neonatal alloimmune thrombocytopenia: the proof of the pudding is in the eating’ at Leiden University.
Promotores
Prof M de Haas MD PhD
Prof E Lopriore MD PhD
Copromotor
Jeanine van Klink MD PhD
News item (Dutch)
Venue
Academy Building, Leiden University
Summary
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare but potentially life threatening disease that can lead to intracranial haemorrhage (ICH) in babies during fetal development and the neonatal period. ICH is associated with perinatal mortality and can lead to long-term neurodevelopmental impairment. If pregnancies at risk for FNAIT are identified upon antenatal screening, timely intervention could prevent the occurrence of fetal ICH. Implementation of population-based screening to prevent FNAIT is hampered by the lack of knowledge on the natural history, whom to treat and costs of case finding. We performed a large nationwide screening study and provide new evidence on the incidence of FNAIT. In addition, we confirm the value of risk factors for immunisation and severe disease. We describe current postnatal treatment strategies and the long-term outcome of cases that were affected by FNAIT. Based on these studies, we conducted a cost-effectiveness analysis comparing the situation with antenatal screening to the current situation without screening. In the general discussion, we evaluate the knowledge gained in this thesis and in the available literature guided by the principles from Wilson and Junger. We conclude that knowledge is available to all principles and nationwide screening for FNAIT during pregnancy seems warranted.
Chapters
Part one: Overview
General introduction and scope of the thesis
Chapter 1
Epidemiology and management of fetal and neonatal alloimmune thrombocytopenia
abstract
Part two: Natural history of HPA-1a mediated FNAIT
Chapter 2
HIP (HPA-screening in pregnancy) study: protocol of a nationwide, prospective and observational study to assess incidence and natural history of fetal/neonatal alloimmune thrombocytopenia and identifying pregnancies at risk
abstract
Chapter 3
Natural history of human platelet antigen (HPA)-1a alloimmunised pregnancies: prospective observational cohort study
Chapter 4
Placental complement activation in fetal and neonatal alloimmune thrombocytopenia: an observational study
abstract
Part three: Clinical relevance of HPA-5b antibodies
Chapter 5
Clinical characteristics of human platelet antigen (HPA)-1a and HPA-5b alloimmunised pregnancies and the association between platelet HPA-5b antibodies and symptomatic fetal neonatal alloimmune thrombocytopenia
abstract
Part four: Neonatal management
Chapter 6
Postnatal treatment for children with fetal and neonatal alloimmune thrombocytopenia: a multicentre, retrospective cohort study
abstract
Part five: Long-term outcome
Chapter 7
Children newly diagnosed with fetal and neonatal alloimmune thrombocytopenia: neurodevelopmental outcome at school age
Chapter 8
Long-term neurodevelopmental outcome in children after antenatal intravenous immune globulin treatment in fetal and neonatal alloimmune thrombocytopenia
abstract
Part six: Cost effectiveness
Chapter 9
Cost-utility analysis of screening of pregnant women for fetal neonatal alloimmune thrombocytopenia
Part seven: Summary and discussion
Chapter 10
General discussion and future perspectives
Download
Download PhD thesis (university repository)
