Q. In Bloody Easy Online Program Module 1, Question 24. A 28-year-old G1P0 has just given birth to a 7lbs girl at 38 weeks gestation. The baby is noted to have some bruising and petechiae. Prenatal course was unremarkable. Ultrasound at 18 weeks was entirely normal. Maternal CBS after delivery shows Hb 100, WBC 11 and platelet 288. CBC from baby reveals Hb 200,WBC 11 and platelet 10. What is the best choice of platelet product for the baby until a definitive diagnosis can be made? Are antibodies not from mom so best answer would be HLA crossmatched platelets as would the mom’s antibodies be present in any platelet concentrate. Is it due to no diagnosis made and time is urgent due to platelet count in newborn?

A. Transfuse maternal platelets to the baby. The rationale is that this thrombocytopenia is likely due to maternal antibodies to a paternal platelet antigen on the infant’s platelets. The quickest reliable source of compatible platelets is the mother, whose platelets will not be affected by antibody to the antigen derived from the fathers genetic constitution. Maternal platelets must be irradiated prior to transfusion, to prevent graft-vs.-host disease. In the event that maternal platelets are not a practical option, platelets negative for the antigen to which the mother is sensitised can be transfused, if available (e.g. HPA-1a antigen negative). In an emergency situation, random donor platelets may be used, while awaiting the delivery of antigen negative platelets.  

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