Antenatal interventions for fetomaternal alloimmune thrombocytopenia

Rayment, Rachel; Brunskill, Susan J; Soothill, Peter; Roberts, David J.; Bussel, James B.; Murphy, Michael

doi:10.1002/14651858.cd004226.pub2

Cited by 29 publications

(15 citation statements)

References 64 publications

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“…Optimal approach for the modern antenatal management of AIT This review has outlined the huge progress in the antenatal management of AIT over the last 20 years. However, the ideal effective treatment without significant side-effects to the mother or fetus has yet to be determined (Rayment et al, 2005).…”

Section: Review ª 2006 the Authorsmentioning

confidence: 99%

Advances in the management of alloimmune thrombocytopenia

Murphy

Bussel

2006

Br J Haematol

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SummaryThere have been considerable advances in the clinical and laboratory diagnosis of alloimmune thrombocytopenia (AIT), and its postnatal and antenatal management. The antenatal management of AIT has been particularly problematic, because severe haemorrhage occurs as early as 16 weeks gestation and there is no non-invasive investigation that reliably predicts the severity of AIT in utero. The strategies for antenatal treatment have included the use of serial platelet transfusions that, while effective, are invasive and associated with significant morbidity and mortality. Maternal therapy involving the administration of intravenous immunoglobulin and/or steroids is also effective and associated with fewer risks to the fetus. Significant recent progress has involved refinement of maternal treatment, stratifying it according to the likely severity of AIT based on the history in previous pregnancies. However, the ideal antenatal treatment, which is effective without causing significant side-effects to the mother or fetus, has yet to be determined, and further clinical trials are needed.

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Section: Review ª 2006 the Authorsmentioning

confidence: 99%

Advances in the management of alloimmune thrombocytopenia

Murphy

Bussel

2006

Br J Haematol

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“…There is no evidence to guide management of FMAIT in GT, but if alloimmunisation occurs, treatment with intravenous immunoglobulin with or without steroids should be considered, as for FMAIT unrelated to inherited platelet disorders. [220][221][222] The zygosity of the father will indicate whether the risk to the baby is 50% or 100%, and amniocentesis with platelet typing may be considered in cases of paternal heterozygosity. This would need cover with platelet transfusion to avoid maternal bleeding.…”

Section: Evidence Level 2+mentioning

confidence: 99%

“…The majority of cases of ICH associated with FMAIT occur in utero and early delivery by caesarean section is usual practice. 222…”

Section: Evidence Level 2+mentioning

confidence: 99%

Management of Inherited Bleeding Disorders in Pregnancy

2017

BJOG

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“…While there is a trend towards higher newborn platelet counts with IVIG and corticosteroids (135 ¥ 10 9 /L) compared with IVIG alone (89 ¥ 10 9 /L), there is no significant reduction in the risk of ICH. 48,49 The main predictor of NAIT severity is the presence and timing of antenatal ICH in a previous sibling, with ICH occurring in early pregnancy predictive of severe disease in the next sibling. There are recently published antenatal treatment guidelines, with treatment stratification based on bleeding severity in previous siblings (see Table 2).…”

Section: Management Of Future Pregnanciesmentioning

confidence: 99%

Review of neonatal alloimmune thrombocytopenia

Risson

Davies

Williams

2012

J Paediatrics Child Health

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Neonatal alloimmune thrombocytopenia (NAIT), with an incidence of one in 1000 live births, is the most common cause of severe thrombocytopenia and intra-cerebral haemorrhage in term neonates. NAIT results from trans-placental passage of maternal antibodies against a paternally derived fetal platelet alloantigen. Clinical presentation varies from unexpected thrombocytopenia on a blood film in a well newborn to intracranial haemorrhage (ICH). In contrast to haemolytic disease of the newborn, NAIT can present in a first pregnancy, and subsequent pregnancies are usually more severely affected. The role of antenatal screening for maternal alloantibodies instead of fetal blood sampling to identify at-risk fetuses remains uncertain, but there is a trend towards less invasive maternally directed treatment for at-risk pregnancies. Neonatal management is aimed at preventing or limiting thrombocytopenic bleeding with transfusion of antigen-matched platelets.

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Antenatal interventions for fetomaternal alloimmune thrombocytopenia

Cited by 29 publications

References 64 publications

Advances in the management of alloimmune thrombocytopenia

Advances in the management of alloimmune thrombocytopenia

Management of Inherited Bleeding Disorders in Pregnancy

Review of neonatal alloimmune thrombocytopenia

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