HOW DO I...?
How do we treat fetal and neonatal alloimmune thrombocytopenia?
Article first published online: 28 APR 2014
© 2014 AABB
Volume 54, Issue 7, pages 1698–1703, July 2014
How to Cite
Bertrand, G. and Kaplan, C. (2014), How do we treat fetal and neonatal alloimmune thrombocytopenia?. Transfusion, 54: 1698–1703. doi: 10.1111/trf.12671
- Issue published online: 14 JUL 2014
- Article first published online: 28 APR 2014
- Manuscript Revised: 27 FEB 2014
- Manuscript Accepted: 27 FEB 2014
- Manuscript Received: 12 SEP 2013
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a potentially devastating disease, seen in one in 800 to 1000 neonates. FNAIT is the most common cause of early-onset isolated severe neonatal thrombocytopenia in maternity wards. The complication of this disorder most to be feared is intracranial hemorrhage, leading to death or to neurologic sequels. As there is no systematic screening of at-risk pregnancies, FNAIT is often discovered when signs of bleeding are observed during pregnancy or at delivery. Platelet transfusion is required in case of bleeding or severe thrombocytopenia (<30 × 109/L) during the 48-hour-postdelivery period. Diagnosis of alloimmunization is important for management of the index case and for subsequent pregnancies, due to the increasing severity of this syndrome as it recurs. Noninvasive antenatal therapy is based on maternal perfusion of intravenous immunoglobulins and risk stratification. In our experience, the addition of corticoids during the last trimester significantly improves the efficiency of treatment. Follow-up of antibody concentration during pregnancy may constitute a useful variable for therapy effectiveness.