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Prospective epidemiologic study of the outcome and cost‐effectiveness of antenatal screening to detect neonatal alloimmune thrombocytopenia due to anti‐HPA‐1a
Author(s) -
Turner Marc L.,
Bessos Hagop,
Fagge Timothy,
Harkness Mairi,
Rentoul Frances,
Seymour Janelle,
Wilson David,
Gray Irene,
Ahya Ridheesh,
Cairns John,
Urbaniak Stan
Publication year - 2005
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2005.00645.x
Subject(s) - medicine , observational study , prospective cohort study , neonatal alloimmune thrombocytopenia , pregnancy , obstetrics , pediatrics , antenatal screening , fetus , biology , genetics
BACKGROUND: To assess the value of antenatal screening to detect neonatal alloimmune thrombocytopenia (NAIT) due to anti‐HPA‐1a, a prospective study was carried out to quantify the potential clinical benefits and determine whether screening would be cost‐effective. STUDY DESIGN AND METHODS: An observational prospective controlled study was carried out on 26,506 pregnant women over 2 years. HPA‐1a phenotyping was performed in the first trimester and women confirmed HPA‐1a‐negative were tested for anti‐HPA‐1a during pregnancy, at delivery, and 10 to 14 days after birth. Babies of HPA‐1a‐negative women were tested at delivery for thrombocytopenia and examined for signs of bleeding. Economic evaluation was undertaken on the basis of the data collected during the study. RESULTS: Twenty‐five of 318 women (7.9%) had anti‐HPA‐1a detected for the first time. Eight women (43 per 100,000) gave birth to babies with NAIT, and 5 (27 per 100,000) had severe thrombocytopenia. Three babies had mild signs of bleeding, and no cases of intracranial hemorrhage (ICH) or fetal loss were detected. It is estimated that it would cost £60,596 (US$98,771) to detect a case of severe NAIT, where anti‐HPA‐1a has been identified for the first time, and £1,151,323 (US$1,876,656) to prevent a case of ICH, assuming that detection allowed successful intervention. CONCLUSIONS: Our data suggest that severe HPA‐1a NAIT is underdiagnosed in the absence of routine antenatal screening. Serious bleeding complications and ICH, however, occur less frequently in first cases of NAIT than suspected from the literature, and the costs of screening and possible intervention must be balanced against the procedural risks.