Fetus-Placenta-Newborn
A less invasive treatment strategy to prevent intracranial hemorrhage in fetal and neonatal alloimmune thrombocytopenia

https://doi.org/10.1067/mob.2001.116727Get rights and content

Abstract

Objective: The purpose of this study was to evaluate whether a less invasive treatment strategy results in a higher platelet count of the neonate and prevents intracranial hemorrhage in pregnant women who are at risk for fetal or neonatal alloimmune thrombocytopenia. Study Design: Between March 1989 and August 2000, 48 women with 56 pregnancies were treated. The population was divided into groups. A diagnostic fetal blood sample was taken in 7 cases that had a history of a sibling with an intracranial hemorrhage (group I; n = 8); treatment was provided, when necessary, with platelet transfusions and maternal administration of immunoglobulin. The other 48 cases, with a history of a sibling with severe thrombocytopenia but without intracranial hemorrhage, were retrospectively divided into group IIa (n = 16) and IIb (n = 32). In group IIa, at least 2 diagnostic fetal blood samples were taken, and when necessary, intrauterine platelet transfusion and immunoglobulin were administered (invasive treatment). In group IIb, no initial diagnostic fetal blood sampling was performed (noninvasive treatment). In 23 cases, immunoglobulin was administered, which was followed by predelivery fetal blood sampling in 8 cases. In 9 cases, only predelivery fetal blood sampling was performed, when necessary, followed by intrauterine platelet transfusion. Results: Results of our noninvasive treatment strategy were comparable to results of the invasive method in the prevention of intracranial hemorrhage (intracranial hemorrhage was not observed). In addition, there was an increasing trend in median platelet count and a lower number of cases with severe thrombocytopenia (<50 × 109/L) in the noninvasive compared with the invasive treatment group (median platelet count, 92 and 31 × 109/L, respectively). Conclusion: Our results indicate that a less invasive treatment strategy in patients who are at risk for fetal or neonatal alloimmune thrombocytopenia and who have no history of a previous child who was affected with intracranial hemorrhage seems justified. (Am J Obstet Gynecol 2001;185:683-8.)

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)

  • L Porcelijn et al.

    Diagnosis and management of fetal platelet disorders

  • C Kaplan et al.

    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].

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