Fetus-Placenta-NewbornA less invasive treatment strategy to prevent intracranial hemorrhage in fetal and neonatal alloimmune thrombocytopenia☆
Section snippets
Methods
Our institution is the national referral center for the treatment of severe fetal or neonatal alloimmune thrombocytopenia in The Netherlands. Between March 1989 and August 2000, 48 women with 56 pregnancies at risk for fetal or neonatal alloimmune thrombocytopenia were treated in the Leiden University Medical Center. In all cases, HPA immunization was confirmed by serologic platelet phenotyping of the parents and by demonstration of specific maternal HPA-antibodies (Central Laboratory for Blood
Invasive treatment of the group with intracranial hemorrhage in the previous child
In 6 women, immunoglobulin was started before the planned fetal blood sampling (Table). In 1 woman, immunoglobulin was started after fetal thrombocytopenia was established by fetal blood sampling. One mother was referred at 34 weeks of gestation, and diagnostic fetal blood sampling revealed severe thrombocytopenia. Despite prompt intrauterine platelet transfusion, massive fetal bleeding from the puncture site complicated the procedure. An emergency cesarean delivery was performed, which
Comment
To the best of our knowledge, this is the first report on such a large population of patients with fetal or neonatal alloimmune thrombocytopenia who were treated in 1 center. We reported on such cases treated in our center before 1994.22 In common with other similar centers, alloimmunized mothers who already had a child with intracranial hemorrhage were treated with at least 2 fetal blood samplings. However, treatment of alloimmunized mothers with a child without intracranial hemorrhage
References (25)
- et al.
The natural history of fetomaternal alloimmunization to the platelet-specific antigen HPA-1a (PlA1, Zwa) as determined by antenatal screening
Blood
(1998) - et al.
Antenatal management of severe feto-maternal alloimmune thrombocytopenia: HLA incompatibility may affect responses to fetal platelet transfusions
Br J Haematol
(1993) - et al.
Very early intracranial haemorrhage in alloimmune fetal thrombocytopenia [letter]
Lancet
(1990) - et al.
Antenatal management of alloimmune thrombocytopenia with intravenous gammaglobulin: a randomized trial of the addition of lowdose steroid to intravenous gammaglobulin
Am J Obstet Gynecol
(1996) - et al.
348 cases of suspected neonatal alloimmune thrombocytopenia
Lancet
(1989) - et al.
Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases
Am J Obstet Gynecol
(1985) - et al.
Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis
Am J Obstet Gynecol
(1995) - et al.
Enhanced sensitization after cordocentesis in a rhesus-isoimmunized pregnancy
Am J Obstet Gynecol
(1991) - et al.
Antenatal care in pregnancies at risk of alloimmune thrombocytopenia: report of 19 cases in 16 families
Eur J Obstet Gynecol Reprod Biol
(1996) - et al.
Neonatal alloimmune thrombocytopenia: antenatal management
Am J Obstet Gynecol
(2000)
Diagnosis and management of fetal platelet disorders
Current trends in neonatal alloimmune thrombocytopenia: diagnosis and therapy
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Reprint requests: Prof Dr H.H.H. Kanhai, Leiden University Medical Center, Department of Obstetrics, K6-P, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail: [email protected].