Fetal alloimmune thrombocytopenia: Consensus and controversy

Abstract

Fetal and neonatal alloimmune thrombocytopenia (AIT) is a serious disease that can affect subsequent siblings to an even greater degree than a first affected child. The devasting outcome of antenatal intracranial hemorrhage (ICH) is not uncommon. Great strides have been made in the antenatal diagnosis and treatment of this disease. This article reviews our knowledge of the laboratory diagnosis of AIT during pregnancy, the pitfalls in this diagnosis, the natural history of AIT during pregnancy, and the collected series of the management of fetal AIT in both Europe and the United States. Discrepancies in outcome between European and American studies exist. Reasons for these discrepancies are highlighted, including differences in populations studied, differences in management, and differences in the definition of response to treatment. Intravenous immune globulin appears to be efficacious in increasing the fetal platelet count and decreasing the occurrence of ICH. © 1996 Wiley‐Liss, Inc.

Antenatal treatment of fetal alloimmune thrombocytopenia: a current perspective

“…7,22 In addition, serial fetal blood sampling and intra-uterine platelet transfusions may further sensitize the mother. 20,24 Finally, if maternal platelets are used in an intra-uterine transfusion, antiplatelet antibodies may be transfused into the fetus with the platelets. 20,25 Overall, as treatment results with maternal IVIG-based therapy have improved substantially 6,7,12,14,16 (Table 3), while the morbidity and mortality from fetal blood sampling remain considerable, the consensus at many centers at present is to minimize its use, and, if possible, to avoid fetal blood sampling completely.…”

“…20 A recent randomized study demonstrated that IVIG 1 g/kg/week alone does not work well in more severely affected patients (i.e., those with previous intracranial hemorrhage or whose initial fetal blood platelet count is £20¥10 9 /L). 12 Among patients treated in the standard-risk arm (platelet count at pre-treatment fetal blood sampling > 20¥10 9 /L and no history of intracranial hemorrhage in a previous sibling), less intensive therapy was appropriate and prednisone 0.5 mg/kg/day was as good as IVIG.…”

“…20,24 Finally, if maternal platelets are used in an intra-uterine transfusion, antiplatelet antibodies may be transfused into the fetus with the platelets. 20,25 Overall, as treatment results with maternal IVIG-based therapy have improved substantially 6,7,12,14,16 (Table 3), while the morbidity and mortality from fetal blood sampling remain considerable, the consensus at many centers at present is to minimize its use, and, if possible, to avoid fetal blood sampling completely. 9,13,15,23 This requires the use of "blind" treatment and, therefore, therapy that will be effective in fetuses with all degrees of severity since; for example, it is unknown whether the fetal platelet count is below or above 20¥10 9 /L without pre-treatment fetal blood sampling.…”

“…), this approach may help to avoid fetal complications ranging from exsanguination to enhanced maternal sensitization and seems feasible in many cases. 20,24,25 …”

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“…The results of antenatal management in these series varied from 0 to 80% depending on the definition of response criteria. Bussel et al (48) observed a tendency towards higher responses in American than in European studies. When response is defined as a fetal platelet count >5Ox1Oy/1 at birth, 29 of the 57 infants (51%) responded.…”