Trente ans d’immunologie plaquettaire dans la prise en charge des thrombopénies fœtales et néonatales allo-immunes, état des lieux

Fetal and neonatal allo-immune thrombocytopenia (FNAIT) is considered as a rare disease due to the incidence (1/1000–1/2000 births). The major complication of severe thrombocytopenia is bleeding and particularly intra-cranial hemorrhage and neurologic sequelae following. Serology and molecular biology developments have reconfigured the platelet immunology diagnosis. Anti-HPA-1a allo-immunisation is responsible for more than 80% FNAIT cases with a high recurrence rate of severe bleeding complications. Therapeutic management has changed over the coming years from an invasive concept associating fetal blood sampling and in utero platelet transfusion to a non invasive treatment by intravenous immunoglobulins injection (IVIg). The purpose of this article is to provide an update on FNAIT management in the light of current developments over the past 30 years.     

Toutankhamon et sicklanémie

After casting doubt on malaria as the cause of death for Tutankhamun [6], the author points out that the hypothesis of homozygotic sickle-cell anaemia, or a double HbS/β₀thal heterozygosis, is hardly more credible. To have any chance of being valid, any such hypothesis would have to involve a combination of at least three rare factors: survival until the age of 19 of a subject with homozygotic sickle-cell anaemia, with a probability at birth as to a life expectancy of more than five years probably standing at less than 5%, and with, for all bone sequelae and anomalies, osteonecrosis whose location is characteristic, not of sickle-cell anaemia, but rather of a case of Freiberg-Kohler syndrome, which is also rare, but which is on the other hand fully compatible with the condition of the mummy’s skeleton.     

La transfusion et ses problématiques particulières en pédiatrie et néonatologie

Principles of transfusion strategy have been used for neonates and children similar to adults. However, due to substantial discrepancies between physiology/pathology in children and in their adult counterparts, decisions, indications, and doses are different from those of adults, especially in neonates. Specific data and practice guidelines for blood product transfusion are reported owing to the experience of pediatrics and neonatology units and partners of the French Blood product bank.