1
|
Abstract
Background: Directed blood donation is defined as the donation of blood or its components for the purpose of transfusion into a specified individual. Directed blood donation holds historic significance, and although practices as of 2021 encourage voluntary, nonrenumerated blood donations, public interest in directed donation remains. Requests to discuss the risks and benefits of directed donations are a common inquiry for transfusion medicine, transplant, and hematology/oncology professionals. This narrative review discusses the history of directed donation and summarizes directed donation considerations in the context of modern transfusion practices. Methods: We conducted a systematic search of PubMed for published literature on the topic of directed blood donation and gathered information about its benefits and potential harms with respect to the variety of products used in transfusion medicine. Results: The drawbacks of directed donation include transfusion-transmitted infection risk, alloimmunization risk, increased transfusion-associated graft vs host disease risk, decreased expediency in treatment, and increased administrative burdens. However, a role remains for directed blood donation in specific patient populations, such as individuals with rare blood types or immunoglobulin A deficiencies, because of the difficulties in finding compatible blood for transfusion. Conclusion: Clinicians should consider the risks and benefits when discussing directed blood donations with patients and family members.
Collapse
|
2
|
Abstract
Fetal thrombocytopenia is most often caused by maternal alloantibodies against fetal platelets crossing the placenta and resulting in platelet destruction. This condition, known as fetal and neonatal alloimmune thrombocytopenia, is usually detected after the birth of a symptomatic child who shows signs of bleeding in the skin or in the brain. In the most severe cases, intracranial hemorrhage leads to severe handicap or death. The challenge for the clinician is to provide preventive treatment in the next pregnancy. The current cornerstone of this treatment is maternal intravenous administration of immunoglobulins during the second half of pregnancy.
Collapse
Affiliation(s)
- L Porcelijn
- Department of Immunohaematology Diagnostic Services, Sanquin Diagnostic Services (CLB), Amsterdam, The Netherlands
| | | | | |
Collapse
|
3
|
Shwe KH, Love EM, Lieberman BA, Newland AC. High-dose intravenous immunoglobulin in the prenatal management of neonatal alloimmune thrombocytopenia. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 13:75-9. [PMID: 2060264 DOI: 10.1111/j.1365-2257.1991.tb00253.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K H Shwe
- Regional Transfusion Centre, Plymouth Grove, Manchester
| | | | | | | |
Collapse
|
4
|
Fetal/Neonatal Allo-Immune Thrombocytopenia (FNAIT): Past, Present, and Future. Obstet Gynecol Surv 2008; 63:239-52. [DOI: 10.1097/ogx.0b013e31816412d3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
van den Akker ES, Oepkes D. Fetal and neonatal alloimmune thrombocytopenia. Best Pract Res Clin Obstet Gynaecol 2008; 22:3-14. [DOI: 10.1016/j.bpobgyn.2007.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
6
|
van den Akker E, Oepkes D, Brand A, Kanhai HHH. Vaginal delivery for fetuses at risk of alloimmune thrombocytopenia? BJOG 2006; 113:781-3. [PMID: 16827760 DOI: 10.1111/j.1471-0528.2006.00993.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the safety of vaginal delivery in pregnancies with fetal and neonatal alloimmune thrombocytopenia (FNAIT). DESIGN Prospective data collection. SETTING Leiden University Medical Centre, the national centre for management of severe red cell and platelet alloimmunisation. POPULATION Thirty-two pregnancies with FNAIT, with a sibling with thrombocytopenia but without an intracranial haemorrhage (ICH). METHODS The mode of delivery, platelet count in cord blood and neonatal outcome were analysed. All women received weekly intravenous immunoglobulin from 32 to 38 weeks of gestation. Head ultrasound scan was performed in all neonates. MAIN OUTCOME MEASURES Signs of ICH or other bleeding in the neonates. RESULTS Twenty-three women delivered vaginally. Nine caesarean sections were performed, all for obstetric reasons. Median platelet count at birth was 142 x 10(9)/l (range, 4-252 x 10(9)/l), with severe thrombocytopenia (<50 x10(9)/l) in four neonates, of which three were born vaginally. None of the neonates showed signs of ICH or other bleeding. CONCLUSIONS In pregnancies with FNAIT and a thrombocytopenic sibling without ICH, vaginal delivery was not associated with neonatal intracranial bleeding. These initial results support our noninvasive management of these pregnancies with FNAIT.
Collapse
Affiliation(s)
- Esa van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | | |
Collapse
|
7
|
Kanhai HHH, van den Akker ESA, Walther FJ, Brand A. Intravenous Immunoglobulins without Initial and Follow-Up Cordocentesis in Alloimmune Fetal and Neonatal Thrombocytopenia at High Risk for Intracranial Hemorrhage. Fetal Diagn Ther 2005; 21:55-60. [PMID: 16354976 DOI: 10.1159/000089048] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 12/10/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report on a less invasive treatment strategy in alloimmune fetal and neonatal thrombocytopenia (FNAIT) at high risk for either in utero or neonatal intracranial hemorrhage (ICH). METHODS In 7 pregnancies, with a history of ICH in the older sibling, weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg) without initial cordocentesis was started at a median gestational age of 16 weeks. RESULTS In 4 pregnancies cordocentesis was avoided. One predelivery cordocentesis with platelet transfusion was performed in 3 further cases. Although none of the cases had a platelet count of >50 x 10(9)/l at cordocentesis, predelivery or birth, no ICHs were observed. The neonatal periods of the infants were uncomplicated. CONCLUSION IVIG treatment alone might be considered in patients with both severe platelet alloimmunization and an increased risk for morbidity and mortality at cordocentesis.
Collapse
Affiliation(s)
- Humphrey H H Kanhai
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | |
Collapse
|
8
|
Davoren A, Curtis BR, Aster RH, McFarland JG. Human platelet antigen-specific alloantibodies implicated in 1162 cases of neonatal alloimmune thrombocytopenia. Transfusion 2004; 44:1220-5. [PMID: 15265127 DOI: 10.1111/j.1537-2995.2004.04026.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonatal alloimmune thrombocytopenia (NATP) caused by fetomaternal mismatch for human platelet (PLT) alloantigens (HPAs) complicates approximately 1 in 1000 to 1 in 2000 pregnancies and can lead to a serious bleeding diathesis, intracranial hemorrhage, and sometimes death of the fetus or neonate. As a national reference center for NATP investigations, our experience with this entity over a 12-year period was reviewed. STUDY DESIGN AND METHODS The laboratory records of all cases of suspected NATP referred for evaluation from January 1, 1990, to December 31, 2002, were analyzed. The spectrum of PLT alloantibody specificities identified was compared with an earlier reported series of serologically verified NATP cases. RESULTS HPA-specific alloantibodies were identified in 1162 (31%) of 3743 sera of mothers of infants with clinically suspected NATP. Maternal HPA-1a (PlA1) alloimmunization accounted for the majority (79%) of confirmed NATP cases, with HPA-5b (Bra), HPA-3a (Baka), and HPA-1b (PLA2) alloantibodies accounting for 9, 2, and 4 percent of cases, respectively. In addition, an increase in the number of cases in which multiple HPA-specific alloantibodies were present in maternal sera was observed during the study period. CONCLUSION Although, as with the earlier series, maternal HPA-1a alloimmunization was the dominant cause of NATP, the identification of an increasing number of cases due to alternative HPA polymorphisms suggests that investigation for HPA-1 incompatibility alone is no longer sufficient to fully evaluate clinically suspect NATP cases.
Collapse
Affiliation(s)
- Anne Davoren
- Blood Center of Southeastern Wisconsin, Milwaukee, Wisconsin 53201-2178, USA.
| | | | | | | |
Collapse
|
9
|
Cremer M, Dame C, Schaeffer HJ, Giers G, Bartmann P, Bald R. Longitudinal thrombopoietin plasma concentrations in fetuses with alloimmune thrombocytopenia treated with intrauterine PLT transfusions. Transfusion 2003; 43:1216-22. [PMID: 12919423 DOI: 10.1046/j.1537-2995.2003.00489.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to describe longitudinal thrombopoietin (TPO) plasma concentrations in fetuses with fetomaternal alloimmune thrombocytopenia (FMAIT). STUDY DESIGN AND METHODS Group 1 was the control group, 8 fetuses with normal hematopoiesis. Group 2 consisted of 4 nonthrombocytopenic fetuses with fetomaternal human PLT antigen incompatibility. Group 3 consisted of 14 fetuses with prenatal-diagnosed severe FMAIT owing to human PLT antigen-1a incompatibility. Fetal PLT counts, MoAb-specific immobilization of PLT antigen score, and TPO plasma concentrations were measured in a total number of 94 serial samples taken by cordocentesis before intrauterine PLT transfusion. RESULTS Normal fetal TPO plasma concentrations ranged between 15 and 119 pg per mL (Group 1 median, 67 pg/mL). In fetuses with risk of FMAIT but normal PLT counts, TPO concentrations were normal (Group 2 median, 72 pg/mL; range, <15-158 pg/mL). In FMAIT with thrombocytopenia, the median TPO concentration was significantly higher than in Groups 1 and 2 (Group 3 median, 172 pg/mL; range, 15-623 pg/mL; p < 0.001). In the longitudinal analysis, TPO concentrations remained constant (n = 8), peaked only transiently (n = 3), or increased at the end of gestation (n = 3). Elevated TPO concentrations (592 and 623 pg/mL) were detected in one patient, who already had intracranial hemorrhage in utero. CONCLUSION TPO concentrations are normal or slightly elevated in FMAIT. Further clinical information can be provided by the longitudinal analysis of TPO concentrations in severe FMAIT.
Collapse
Affiliation(s)
- Malte Cremer
- Department of Neonatology, University of Bonn, Bonn, Germany.
| | | | | | | | | | | |
Collapse
|
10
|
Radder CM, Brand A, Kanhai HHH. Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it? Vox Sang 2003; 84:318-25. [PMID: 12757506 DOI: 10.1046/j.1423-0410.2003.00302.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Intracranial haemorrhage (ICH) of the fetus or newborn is a severe complication of fetal or neonatal alloimmune thrombocytopenia (FNAIT). In order to attain management decisions to prevent ICH, the risk of ICH in successive pregnancies with thrombocytopenia, with or without a history of ICH, must be established. MATERIALS AND METHODS We performed a search of medline for ICH cases in untreated FNAIT pregnancies. After exclusion of cases with confounding factors, 24 reports, describing 62 pregnancies of 27 mothers, were eligible. In addition, two mothers with five pregnancies were included from our own case records. Observational studies were examined to estimate the risk of ICH in subsequent FNAIT pregnancies without a history of ICH. Finally, medline was searched for complication rates in the treatment of FNAIT pregnancies. RESULTS In 52% of the ICH cases, a previous sibling suffered from ICH. The recurrence rate of ICH in the subsequent offspring of women with a history of FNAIT with ICH was 72%[confidence interval (CI): 46-98%] without inclusion of fetal deaths and 79% (CI: 61-97%) with inclusion of fetal deaths. In 48% of the ICH cases, the previous sibling had thrombocytopenia but not ICH. Population studies revealed an overall ICH risk in thrombocytopenic infants of 11% (CI: 0.8-23%) without inclusion of fetal deaths and 15% (CI: 1.5-19%) with inclusion of fetal deaths. Assuming occurrence in 48%, the risk of ICH in a subsequent pregnancy following a history of FNAIT without ICH, was estimated to be 7% (CI: 0.5-13%). Invasive treatment strategies carry a risk of 2.8% (CI: 1.2-4.4%) on complications. CONCLUSIONS The number of eligible publications on ICH in untreated FNAIT pregnancies is strikingly limited. The recurrence rate is high. As sufficient data on successive FNAIT cases without ICH are lacking, the occurrence of ICH in pregnancies with thrombocytopenia, but without ICH in a previous sibling, cannot be predicted. We estimate this risk to be 7%. This risk must be balanced against the risk of interventions in treatment strategies.
Collapse
Affiliation(s)
- C M Radder
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
| | | | | |
Collapse
|
11
|
Radder CM, Brand A, Kanhai HH. A less invasive treatment strategy to prevent intracranial hemorrhage in fetal and neonatal alloimmune thrombocytopenia. Am J Obstet Gynecol 2001; 185:683-8. [PMID: 11568798 DOI: 10.1067/mob.2001.116727] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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 x 10(9)/L) in the noninvasive compared with the invasive treatment group (median platelet count, 92 and 31 x 10(9)/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.
Collapse
Affiliation(s)
- C M Radder
- Leiden University Medical Center, Department of Obstetrics, The Netherlands
| | | | | |
Collapse
|
12
|
Blanchette VS, Johnson J, Rand M. The management of alloimmune neonatal thrombocytopenia. Best Pract Res Clin Haematol 2000; 13:365-90. [PMID: 11030040 DOI: 10.1053/beha.2000.0083] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neonatal alloimmune thrombocytopenia (NAITP), defined as thrombocytopenia (platelet count < 150 x 10(9)/l) due to transplacentally acquired maternal platelet alloantibodies, occurs in approximately 1 per 1200 live births in a Caucasian population. In such a population, the majority (> 75 percent) of cases are due to fetomaternal incompatibility for the platelet specific alloantigen, HPA-1a (P1A1, Zwa). Incompatibility for the HPA-5b (Bra) alloantigen is the next most frequent cause of NAITP in Caucasians; much less common is NAITP due to incompatibility for HLA, blood group ABO or other platelet-specific antigens. In non-Caucasian populations (e.g. Orientals) HPA-1a incompatibility is a rare cause of NAITP and other alloantigens e.g. HPA-4b (Penb, Yuka) are implicated. The greatest clinical challenge relates to the antenatal management of pregnant women alloimmunized to the HPA-1a (P1A1, Zwa) antigen, and particularly the subset of such women who have a history of a previously affected infant with severe thrombocytopenia and/or intracranial hemorrhage (ICH). The risk of antenatal ICH in the fetus of such women is high enough to merit intervention, either weekly infusion of high-dose intravenous immunoglobulin G (IVIG) with or without corticosteroids given to the mother (the preferred approach in North American centres), or repeated in-utero fetal platelet transfusions (the preferred treatment approach in some European centres). Post-natal management of severely affected infants centres on the rapid provision of compatible antigen-negative platelets harvested from the mother or a phenotyped donor. The value of antenatal screening programs to detect 'at risk' alloimmunized women during pregnancy continues to be debated.
Collapse
Affiliation(s)
- V S Blanchette
- University of Toronto, Hospital for Sick Children, ON, Canada
| | | | | |
Collapse
|
13
|
Silver RM, Porter TF, Branch DW, Esplin MS, Scott JR. Neonatal alloimmune thrombocytopenia: antenatal management. Am J Obstet Gynecol 2000; 182:1233-8. [PMID: 10819864 DOI: 10.1067/mob.2000.104841] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The optimal management of pregnancies at risk for neonatal alloimmune thrombocytopenia is debated. Proposed management includes the administration of intravenous immunoglobulin and serial determination of the fetal platelet count. The aims of our study were to determine the effectiveness and likely mechanism of action of intravenous immunoglobulin and to evaluate the safety of cordocentesis in cases of neonatal alloimmune thrombocytopenia. STUDY DESIGN Eighteen mother-infant pairs were studied. All were at risk for neonatal alloimmune thrombocytopenia on the basis of delivery of a previously affected infant and confirmation of specific maternal antiplatelet antibodies. The pertinent antigen was HPA-1a in 13 cases, HPA-3a in 2 cases, and undetermined in 3 cases. Serial cordocenteses were used to determine fetal platelet counts. If the platelet count was <50,000/microL before 37 weeks' gestation, treatment was initiated with intravenous immunoglobulin administered to either the fetus (n = 2) or the mother (n = 8). In 3 cases fetal and maternal immunoglobulin G levels were determined before and after treatment. RESULTS Seven (39%) fetuses had adequate platelet counts, were not treated, and were delivered of infants with normal platelet counts. Eleven (61%) fetuses were thrombocytopenic. Eight thrombocytopenic infants were treated with maternally administered intravenous immunoglobulin. In 6 (75%) of 8 cases the fetal platelet count increased after administration of intravenous immunoglobulin, but 2 fetuses remained severely thrombocytopenic. Two thrombocytopenic fetuses were treated with intravenous immunoglobulin infusion directly into the umbilical vein; both remained thrombocytopenic. Moreover, fetal immunoglobulin G levels did not correlate well with the response to intravenous immunoglobulin. Two (5.3%) of 38 cordocenteses were complicated by hemorrhagic complications, necessitating immediate cesarean delivery despite the use of prophylactic platelet transfusion in one case. CONCLUSION Severe fetal alloimmune thrombocytopenia does not always occur in subsequent fetuses. Thus either fetal antigen status or platelet counts or both of these are necessary to determine whether treatment is needed. The effect of intravenous immunoglobulin on raising the fetal platelet count is inconsistent and appears to be caused by maternal or placental factors rather than a direct inhibition of fetal platelet destruction by immunoglobulin. The risk of hemorrhagic complications from cordocentesis in pregnancies complicated by neonatal alloimmune thrombocytopenia is higher than generally appreciated and is not always avoided by platelet transfusion at the time of the procedure.
Collapse
Affiliation(s)
- R M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | | | | | | | | |
Collapse
|
14
|
Savoia HF, Brennecke SP, Burrows RF, Hart CF, Holdsworth R, Metz J, Permezel M, Tippett C, Wallace EM. Investigation and management of fetomaternal alloimmune thrombocytopenia. Aust N Z J Obstet Gynaecol 2000; 40:176-9. [PMID: 10925905 DOI: 10.1111/j.1479-828x.2000.tb01142.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H F Savoia
- Department of Perinatal Medicine and University of Melbourne, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
The obstetric literature contains numerous reports of IVIG therapy for various conditions encountered during pregnancy. The mechanisms of action of IVIG are uncertain and may vary depending on the specific disorder. Immunoglobulin G infusions appear to be well tolerated by the parturient. The occurrence of major and minor side effects is uncommon, and infectious morbidity is low. Further research will be necessary to elucidate the specific mechanisms of action of IVIG in certain disease states. Determining the exact "therapeutic agent" in IVIG for each specific disease state may allow for a more tailored approach to treatment (i.e., isolation or production of the particular antibody). Outcome assessment, long-term positive and negative effects, cost-benefit analysis, and effects on fetal and neonatal immune function require further study through randomized trials.
Collapse
Affiliation(s)
- A L Clark
- Department of Obstetrics and Gynecology, University of Louisville, KY 40292, USA
| |
Collapse
|
16
|
Porcelijn L, von dem Borne AE. Immune-mediated thrombocytopenias: basic and immunological aspects. BAILLIERE'S CLINICAL HAEMATOLOGY 1998; 11:331-41. [PMID: 10097811 DOI: 10.1016/s0950-3536(98)80052-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acute idiopathic or autoimmune thrombocytopenic purpura (AITP) is a disorder found mainly in children, usually preceded by a viral infection, with a higher incidence in the autumn and winter. The platelet-specific autoantibodies in acute childhood AITP are more often of the IgM class. Chronic AITP occurs mostly in adults. The platelet immunofluorescence test (PIFT) detects platelet-specific autoantibodies with a sensitivity of 65-75%. The autoantibodies in chronic AITP are classified as IgG in 95%, IgM in 26% and IgA in 4% of cases. The antibodies are usually bound to platelets and are detectable as free circulating antibodies in about 40%. AITP in pregnancy may cause neonatal AITP by autoantibodies of the IgG class which pass the placenta barrier. The rare neonatal alloimmune thrombocytopenic purpura (NAITP) are caused by IgG alloantibodies against HPA-1a in 75-90%, HPA1b in 3-5%, HPA 3a in 4-5%, HPA5b in 6-19% and against private platelet antigens in 3%. To confirm the diagnosis of NAITP requires extensive serological testing of the child, and the parents have to be typed for the important platelet-specific antigens by PIFT, monoclonal antibody immobilisation of platelet antigens (MAIPA) and/or enzyme-linked immunosorbent assay (ELISA) techniques. Three mechanisms of drug-induced thrombocytopenias are described. Platelets of both the donor and the patient are destroyed in post-transfusion thrombocytopenic purpura (PTP) but PTP does not occur again if incompatible platelets are re-administered.
Collapse
Affiliation(s)
- L Porcelijn
- Department of Experimental Immunohematology, CLB, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | |
Collapse
|
17
|
Abstract
In idiopathic thrombocytopenic purpura, the low risk of fetal bleeding in the perinatal period does not justify routine cordocentesis. Platelet counts of second newborns correlates well with that of their siblings. In neonatal alloimmune thrombocytopenia, the initial platelet count at cordocentesis in the second trimester is low in the next pregnancy. Weekly high doses of intravenous gammaglobulin to the mother results in a rise of fetal platelet count in approximately 70% of cases and may protect the fetus against intracranial haemorrhage in cases without significant platelet rise. With the exception of cases with a prior infant with spontaneous fetal intracranial haemorrhage, the use of diagnostic fetal blood sampling to confirm neonatal alloimmune thrombocytopenia is controversial.
Collapse
Affiliation(s)
- L Porcelijn
- CLB, Sanguin Blood Supply Foundation, Amsterdam, The Netherlands
| | | |
Collapse
|
18
|
Westman P, Hashemi-Tavoularis S, Blanchette V, Kekomäki S, Laes M, Porcelijn L, Kekomäki R. Maternal DRB1*1501, DQA1*0102, DQB1*0602 haplotype in fetomaternal alloimmunization against human platelet alloantigen HPA-6b (GPIIIa-Gln489). TISSUE ANTIGENS 1997; 50:113-8. [PMID: 9271820 DOI: 10.1111/j.1399-0039.1997.tb02849.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fetomaternal incompatibility of platelet alloantigens may lead to alloimmunization and neonatal alloimmune thrombocytopenia (NAIT). Human platelet alloantigen (HPA) 6b, which associates with residue Gln 489 of platelet membrane glycoprotein IIIa, has been described as a cause of NAIT. We have studied the MHC genes of all available family members in the six thus far reported families with a thrombocytopenic newborn and fetomaternal HPA-6b incompatibility. Maternal HPA-6b antibodies could be detected in five mothers to the altogether seven thrombocytopenic male infants. The MHC genes HLA-DRB, -DQA1, -DQB1, -DPB1, TAP1,2 and HSP70-Hom were studied by using polymerase chain reaction (PCR)-based DNA analysis methods. All five mothers with detectable circulating HPA-6b antibodies at the time of delivery shared an identical DRB1*1501, DQA1*0102, DQB1*0602 haplotype. The sixth, HPA antibody negative mother and a HPA-6b-negative mother to a healthy HPA-6b+ child were negative for this haplotype. The frequency of DRB1*15-positive haplotype was increased in immunized mothers (100%) as compared with the general Finnish population (27%), but the association was not statistically significant after correction. We conclude that there is a potential association between the MHC haplotype DRB1*1501, DQA1*0102, DQB1*0602 and alloimmunization to the HPA-6b antigen and that this alloimmunization probably involves different HLA class II molecules from immunization to HPA-1a.
Collapse
Affiliation(s)
- P Westman
- Finnish Red Cross Blood Transfusion Service, Helsinki, Finland.
| | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Intravenous immunoglobulin was licensed for use in the United States in 1981. Currently, there are only a few Food and Drug Administration-labeled indications for intravenous immunoglobulin, but up to 50 "off-label" uses are reported in the literature. The obstetric literature contains numerous reports on intravenous immunoglobulin therapy during pregnancy. This article reviews the properties, pharmacokinetics, mechanisms of action, and side effects of intravenous immunoglobulin, as well as the reported uses of intravenous immunoglobulin during pregnancy.
Collapse
Affiliation(s)
- A L Clark
- Department of Obstetrics and Gynecology, University of Louisville, KY 40292, USA
| | | |
Collapse
|
20
|
Abstract
We report two patients where the finding of isolated fetal hydrocephalus led to the detection of severe fetal thrombocytopenia, using fetal blood sampling. Serological investigation led to the diagnosis of fetomaternal alloimmune thrombocytopenia (FMAIT) due to anti-HPA-1a. Both women had had previous unsuccessful pregnancies probably due to FMAIT; one had had four miscarriages at 17-18 weeks' gestation. The other had had one previous pregnancy complicated by severe fetal anaemia, and eventually hydrocephalus developed and the fetus died without the diagnosis of FMAIT being considered. Subsequent pregnancies in the two women were also affected by FMAIT, but prenatal treatment, predominantly with serial fetal platelet transfusions, resulted in a successful outcome in both cases. These observations suggest that FMAIT should be suspected if there is isolated fetal hydrocephalus, unexplained fetal anaemia, or recurrent miscarriages. The accurate diagnosis of FMAIT is important because recent advances in prenatal management can improve the outcome of subsequently affected pregnancies.
Collapse
Affiliation(s)
- M F Murphy
- Department of Haematology, St Bartholomew's Hospital, King's College Hospital, London, U.K
| | | | | | | |
Collapse
|
21
|
Win N. Provision of random-donor platelets (HPA-1a positive) in neonatal alloimmune thrombocytopenia due to anti HPA-1a alloantibodies. Vox Sang 1996; 71:130-1. [PMID: 8873427 DOI: 10.1046/j.1423-0410.1996.7120130.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
22
|
Panzer S, Auerbach L, Cechova E, Fischer G, Holensteiner A, Kitl EM, Mayr WR, Putz M, Wagenbichler P, Walchshofer S. Maternal alloimmunization against fetal platelet antigens: a prospective study. Br J Haematol 1995; 90:655-60. [PMID: 7647006 DOI: 10.1111/j.1365-2141.1995.tb05597.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neonatal alloimmune thrombocytopenia (NAIT) is induced by maternal alloantibodies to fetal platelet antigens. This prospective study was carried out to evaluate the incidence of anti-platelet antibodies in 933 mother-child pairs where the mother and child were typed for the human platelet antigens (HPA)-1, -2, -3, -5. Sera from mismatched mother-child pairs were screened for anti-platelet antibodies, anti-HLA class I and blood group ABO IgG antibodies. Platelet-specific antibodies were anti-HPA-3a in one and anti-HPA-5b in 17 neonates, respectively. All these neonates had normal platelet counts. One woman had autoreactive antibodies. Anti-HLA class I and anti-blood group A IgG antibodies were detected in five and four neonates, respectively, born with a platelet count < 150 x 10(9)/l. None of the 11 homozygous HPA-1b mothers became immunized against their heterozygous offspring. The maternal HLA-allotypes HLA-DR52 and -DR6, typically found in individuals immunized against HPA-1a and -5b, respectively, were found in three of 11 HPA-b/b nonresponders and eight of the anti-HPA-5b responders. The results indicate that a risk for NAIT due to HPA-2 and -3 alloimmunization is low. The HLA allotypes do not predict the risk for NAIT due to HPA-1 or -5 alloimmunization. Maternal anti-HPA-5b antibodies do not correlate with the platelet count in the neonate.
Collapse
Affiliation(s)
- S Panzer
- Clinical Department for Blood Group Serology, University of Vienna, Austria
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Murphy MF, Waters AH, Doughty HA, Hambley H, Mibashan RS, Nicolaides K, Rodeck CH. Antenatal management of fetomaternal alloimmune thrombocytopenia--report of 15 affected pregnancies. Transfus Med 1994; 4:281-92. [PMID: 7889140 DOI: 10.1111/j.1365-3148.1994.tb00265.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The recognition that spontaneous intracranial haemorrhage (ICH) may occur in utero in fetomaternal alloimmune thrombocytopenia (FMAIT) led us to attempt to prevent this in 15 pregnancies of 11 women who had previously affected infants with FMAIT due to anti-HPA-1a. The antenatal management included fetal platelet transfusions and maternal steroids and/or high-dose intravenous immunoglobulin (IVIgG). In the first pregnancy, ICH occurred between 32 and 35 weeks' gestation before any treatment had been given, emphasizing the need for earlier intervention. Five of the 14 subsequent pregnancies in this study were considered to be severely affected (severe haemorrhagic complications in a previous infant and initial fetal platelet count < 20 x 10(9)/L in this study); four were managed successfully with weekly fetal platelet transfusions started between 18 and 29 weeks and continued until delivery at 33-35 weeks, and one severely affected case who was referred at 36 weeks was managed successfully with a single platelet transfusion prior to delivery. Five pregnancies were considered to be mildly affected (previous infants were unaffected by severe bleeding and initial fetal platelet count > 50 x 10(9)/L in this study). The platelet counts were maintained in one case with steroids and in three with IVIgG without the need for repeated platelet transfusions, but in the fifth the fetal platelet count fell despite steroids and IVIgG and serial platelet transfusions were required. Four pregnancies were unsuccessful; two pregnancies were terminated after severe ICH occurred at an early stage before fetal blood sampling had been carried out, one fetus died after the mother had a severe fall despite the successful initiation of fetal platelet transfusions and one died due to a cord haematoma which occurred at the time of the initial fetal blood sampling. The optimal management of FMAIT to reduce the risk of antenatal ICH remains uncertain. Steroids and IVIgG may be effective in some mildly affected cases but serial fetal platelet transfusions are the preferred therapy for those who are severely affected.
Collapse
Affiliation(s)
- M F Murphy
- Department of Haematology, St Bartholomew's Hospital, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
24
|
Warwick RM, Vaughan J, Murray N, Lubenko A, Roberts I. In vitro culture of colony forming unit-megakaryocyte (CFU-MK) in fetal alloimmune thrombocytopenia. Br J Haematol 1994; 88:874-7. [PMID: 7819112 DOI: 10.1111/j.1365-2141.1994.tb05130.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Perinatal alloimmune thrombocytopenia (PAITP) causes intracranial haemorrhage in the fetus and neonate. However, the severity of the thrombocytopenia correlates poorly with maternal anti-platelet antibody titres. To test the hypothesis that reduced platelet production contributes to fetal thrombocytopenia in PAITP, maternal sera from three HPA-1a-negative mothers whose pregnancies were complicated by anti-HPA-1a (two severe cases, one mild case) were added to colony forming unit-megakaryocyte (CFU-MK) cultures from HPA-1a positive and negative individuals. Sera from the two severely affected pregnancies containing anti-HPA-1a caused 66-100% inhibition of HPA-1a-positive fetal and neonatal CFU-MK, whereas CFU-MK from two HPA-1a-negative mothers were not inhibited by the anti-HPA-1a-containing sera. Maternal serum from the case of mild PAITP caused only mild inhibition of HPA-1a-positive cord and adult CFU-MK and did not inhibit HPA-1a-positive fetal CFU-MK. Taken together, these findings suggest that reduced megakaryocyte production contributes to fetal thrombocytopenia due to maternal anti-HPA-1a antibodies and also that the degree of CFU-MK inhibition correlates with severity of fetal thrombocytopenia.
Collapse
|
25
|
Marzusch K, Wiest E, Pfeiffer KH, Grubbe G, Schnaidt M. Antenatal fetal therapy for neonatal allo-immune thrombocytopenia with high dose immunoglobulin. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1994; 101:1011-3. [PMID: 7999711 DOI: 10.1111/j.1471-0528.1994.tb13052.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- K Marzusch
- Department of Obstetrics and Gynaecology, University of Tuebingen, Germany
| | | | | | | | | |
Collapse
|
26
|
Simsek S, Christiaens GC, Kanhai HH, Beekhuis JR, Bleeker PM, Vlekke AB, Goldschmeding R, von dem Borne AE. Human platelet antigen-1 (Zw) typing of fetuses by analysis of polymerase chain reaction-amplified genomic DNA from amniocytes. Transfus Med 1994; 4:15-9. [PMID: 7516786 DOI: 10.1111/j.1365-3148.1994.tb00238.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Prenatal typing for the human platelet antigens-1 (HPA) permits identification of a fetus at risk for neonatal alloimmune thrombocytopenia (NAITP) in cases of HPA-1 incompatibility in which the father is heterozygous for the HPA-1a antigen. Diagnostic cordocentesis and phenotyping of the fetal platelets are used for this purpose. We applied allele-specific restriction enzyme analysis on polymerase chain reaction (PCR)-amplified DNA purified from amniocytes. This assays allows early second trimester typing for HPA-1 alleles. We were able to determine the genotype of three fetuses at risk. Iatrogenic fetal loss is lower with amniocentesis than with cordocentesis. Therefore, this technique is a welcome addition to the antenatal management of NAITP.
Collapse
Affiliation(s)
- S Simsek
- Department of Immunological Haematology, University of Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Lee A, Permezel M, Dennington P, Duke T, Doyle L, Robinson H. Neonatal alloimmune thrombocytopenia. A case report and a review of the literature. Aust N Z J Obstet Gynaecol 1993; 33:420-3. [PMID: 8179559 DOI: 10.1111/j.1479-828x.1993.tb02127.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 32-year-old woman in her third pregnancy underwent fetal blood sampling because of a previous child with neonatal thrombocytopenia. At 33 weeks' gestation, fetal thrombocytopenia was diagnosed. Treatment was instituted antenatally with serial fetal platelet transfusions and corticosteroid therapy. Delivery was by Caesarean section at 37 weeks' gestation. Neonatal treatment included further platelet transfusion and immunoglobulin infusion. Recovery of the neonate was complete on discharge from hospital 10 days after birth. The aetiology, diagnosis, clinical presentations and therapeutic options in cases of alloimmune thrombocytopenia are discussed.
Collapse
Affiliation(s)
- A Lee
- Royal Women's Hospital, University of Melbourne, Carlton
| | | | | | | | | | | |
Collapse
|
28
|
Reesink HW, Engelfriet CP, Décary F, Goldman M, Kaplan C, Kelsey HC, Rodeck CH, Waters AH, Mueller-Eckhardt C, Giers G, Bald R, Leeuwen EF, Kanhai HHH, Brand A, Bussel JB. Prenatal Management of Fetal Alloimmune Thrombocytopenia: Editorial. Vox Sang 1993. [DOI: 10.1111/j.1423-0410.1993.tb02144.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Dunsmore KP, Friedman HS, Kurtzberg J. The uses of intravenous immunoglobulin in pediatrics. An update. Crit Rev Oncol Hematol 1992; 12:67-90. [PMID: 1590942 DOI: 10.1016/1040-8428(92)90085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- K P Dunsmore
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710
| | | | | |
Collapse
|
30
|
Marzusch K, Schnaidt M, Dietl J, Wiest E, Hofstaetter C, Gölz R. High-dose immunoglobulin in the antenatal treatment of neonatal alloimmune thrombocytopenia: case report and review. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1992; 99:260-2. [PMID: 1606126 DOI: 10.1111/j.1471-0528.1992.tb14511.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- K Marzusch
- Department of Obstetrics and Gynaecology, University of Tuebingen, FRG
| | | | | | | | | | | |
Collapse
|
31
|
Kurtzberg J, Dunsmore KP. IVIG therapy in neonatal isoimmune thrombocytopenic purpura and alloimmunization thrombocytopenia. CLINICAL REVIEWS IN ALLERGY 1992; 10:73-80. [PMID: 1606525 DOI: 10.1007/978-1-4612-0417-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J Kurtzberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710
| | | |
Collapse
|
32
|
Pietz J, Kiefel V, Sontheimer D, Kobialka B, Linderkamp O, Mueller-Eckhardt C. High-dose intravenous gammaglobulin for neonatal alloimmune thrombocytopenia in twins. ACTA PAEDIATRICA SCANDINAVICA 1991; 80:129-32. [PMID: 2028785 DOI: 10.1111/j.1651-2227.1991.tb11746.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report the successful treatment of neonatal alloimmune thrombocytopenia with repeated infusions of high-dose immunoglobulin G (400 mg/kg/d for 5 days) in twins. Platelet counts increased within 3 days from less than 20 x 10(9)/l to more than 70 x 10(9)/l. The first twin survived without neurological or other sequelae. The second twin had probably developed intracranial hemorrhage (ICH) in utero. This infant developed long-term neurological sequelae with blindness, cerebral palsy and infantile spasms. Implications of the therapeutic approach and prevention of severe complications in pregnancies with known risk for neonatal alloimmune thrombocytopenia are discussed.
Collapse
Affiliation(s)
- J Pietz
- Division of Neonatology, Children's Hospital, University of Heidelberg, Federal Republic of Germany
| | | | | | | | | | | |
Collapse
|
33
|
Saving KL, McLaren RA, Miller TC, O'Connor M. Responsibility expands to extended family members. Am J Obstet Gynecol 1990; 163:1369-70. [PMID: 2220955 DOI: 10.1016/0002-9378(90)90731-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
34
|
Eisen M, Motum P, Gibson J, Uhr E, Gett M, Kronenberg H, Wylie B. Neonatal alloimmune thrombocytopenia caused by an antibody to the Bak(a) antigen. Pathology 1990; 22:203-5. [PMID: 2091003 DOI: 10.3109/00313029009086663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 31 year old woman was assessed following delivery of her second child affected by neonatal alloimmune thrombocytopenia (NAIT). Antiplatelet antibodies with specificity for Bak(a) were identified in the woman's serum and her platelets were typed as Bak(a) negative whilst her husband's were Bak(a) positive. Unlike the majority of reported anti-Bak(a) antibodies in the literature, this patient's serum contained no contaminating anti-HLA antibodies. This is the first report of NAIT caused by an anti-Bak(a) without co-existing anti-HLA antibodies. An anti-Bak(a) antibody has not previously been reported in Australia. The current status of this antigen system is reviewed.
Collapse
Affiliation(s)
- M Eisen
- N.S.W. Red Cross Blood Transfusion Service, Royal Prince Alfred Hospital, Sydney
| | | | | | | | | | | | | |
Collapse
|
35
|
Adriaans B, Pullon H, Du Vivier A, Mibashan R. Pemphigoid gestationis and neonatal alloimmune thrombocytopenia. Clin Exp Dermatol 1990; 15:134-6. [PMID: 2189606 DOI: 10.1111/j.1365-2230.1990.tb02050.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A patient whose second, third and fourth pregnancies were complicated by alloimmune thrombocytopenia, developed pemphigoid gestationis after the fourth pregnancy. The infant was delivered by Caesarean section at 34 weeks gestation. The pemphigoid gestationis resolved promptly after a short course of systemic corticosteroids. A possible association between these two uncommon conditions is discussed.
Collapse
Affiliation(s)
- B Adriaans
- Department of Dermatology, King's College Hospital, Denmark Hill, London, UK
| | | | | | | |
Collapse
|
36
|
Abstract
Percutaneous umbilical blood sampling (PUBS), also called cordocentesis, is a newly introduced technique that enables blood samples to be obtained from the fetus in utero for a variety of conditions. The major applications are for the diagnosis of fetal infections, karyotype analysis, fetal growth retardation, diagnosis of hematologic conditions, and metabolic evaluation. This procedure is gaining in popularity, since it provides direct information on fetal blood status. It can be applied to therapeutic manipulations such as in utero transfusions or drug administration. The procedure is remarkably safe and has few technical problems. The applicability of its use in the assessment of fetal thrombocytopenia is also discussed in detail.
Collapse
Affiliation(s)
- R A Sacher
- Department of Medicine (Division of Hematology), Georgetown University Hospital, Washington, D.C
| | | |
Collapse
|
37
|
Murphy MF, Pullon HW, Metcalfe P, Chapman JF, Jenkins E, Waters AH, Nicolaides KH, Mibashan RS. Management of fetal alloimmune thrombocytopenia by weekly in utero platelet transfusions. Vox Sang 1990; 58:45-9. [PMID: 2316210 DOI: 10.1111/j.1423-0410.1990.tb02054.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Alloimmune neonatal thrombocytopenia (ANT) may cause intracranial haemorrhage in utero as well as at delivery. Recent management has concentrated on attempts to minimise fetal thrombocytopenia and prevent its complications. This report describes further experience with the use of repeated intravascular transfusions of compatible platelets in utero. The patient studied had already had one infant with intracranial haemorrhage due to ANT. In her next pregnancy, weekly intra-uterine platelet transfusions were given from 26 weeks, but intra-uterine death occurred at 30 weeks after the mother had a heavy fall. In her most recent pregnancy, weekly intravascular transfusions of platelets were given by cordocentesis from 29 to 34 weeks. The fetal platelet count was maintained above 30 X 10(9)/l for almost all of the last 6 weeks of pregnancy before delivery of a normal infant by Caesarean section at 35 weeks' gestation. This approach is effective in preventing severe fetal thrombocytopenia in the last trimester of pregnancy and is contrasted with alternative treatments of ANT. Further data are required to determine the efficacy and risks of these treatments.
Collapse
Affiliation(s)
- M F Murphy
- Department of Haematology, St. Bartholomew's Hospital and Medical College, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal alloantibodies to antigens present on fetal platelets cause their immune destruction resulting in thrombocytopenia in the newborn infant or fetus. Bleeding may be severe; intracranial haemorrhage and permanent neurological damage are the most serious complications. Despite the severity of the disease, there is often a delay in making the correct diagnosis and instigating appropriate treatment. Recent evidence that NAIT is more common than has previously been recognised, a better understanding of the molecular basis of platelet serology and advances in technology, which have made it possible to take blood samples from fetuses and transfuse them in utero, have all contributed to a growing interest in this condition. In addition, it is exciting to realise that an aggressive approach to the management of established cases and 'at risk' pregnancies can prevent serious neurological sequelae and dramatically improve the outcome for affected infants.
Collapse
Affiliation(s)
- P O Skacel
- Department of Haematology, Northwick Park Hospital, Harrow, Middlesex, UK
| | | |
Collapse
|