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

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Download PhD thesis (university repository)

Thesis Thijs de Vos