Abstract
IntroductionIn pregnant women with a history of fetal and neonatal alloimmune thrombocytopenia (FNAIT), prenatal intervention in subsequent pregnancies may be required to prevent fetal bleeding. Several invasive and non-invasive protocols have been published: amniocentesis for fetal genotyping, fetal blood sampling for the determination of fetal platelet count, intrauterine platelet transfusions, and weekly maternal i.v. immunoglobulin (IVIG) infusion with or without additional corticosteroid therapy. This is the first retrospective study that report the experience with a non-invasive protocol focused on side effects of maternal IVIG treatment and neonatal outcome.MethodsPregnant women with proven FNAIT in history and an antigen positive fetus were treated with IVIG (1 g/kg/bw) every week. To identify potential IVIG-related hemolytic reactions isoagglutinin titer of each IVIG lot and maternal blood count were controlled. IVIG-related side effects were prospectively documented and evaluated. Furthermore, ultrasound examination of the fetus was performed before starting IVIG administration and continued regularly during treatment. Outcome of the index and subsequent pregnancy was compared. Corresponding data of the newborns were analyzed simultaneously.ResultsIVIG was started at 20 weeks of gestation (median). Compared to the index pregnancy, platelet counts of the newborns were higher in all cases. No intracranial hemorrhage occurred (Index pregnancies: 1 case). Platelet counts were 187 × 109/l (median, range 22–239, 95% CI) and one newborn had mild bleeding. No severe hemolytic reaction was observed and side effects were moderate.ConclusionAmong pregnant women with FNAIT history, the use of non-invasive fetal risk determination and maternal IVIG resulted in favorite outcome of all newborns. Invasive diagnostic or therapeutic procedures in women with a history of FNAIT should be abandoned.
Highlights
In pregnant women with a history of fetal and neonatal alloimmune thrombocytopenia (FNAIT), prenatal intervention in subsequent pregnancies may be required to prevent fetal bleeding
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal alloantibodies that are directed against fetal human platelet antigens (HPAs) inherited from the father
In view of published results of a case series that did not report any therapeutic effect of maternal i.v. immunoglobulin (IVIG) prophylaxis on fetal platelet counts [10] and lack of systematic evaluation of potential adverse effects of IVIG, we retrospectively evaluated the antenatal management of FNAIT in 12 subsequent patients that were treated according to a standardized local protocol
Summary
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal alloantibodies that are directed against fetal human platelet antigens (HPAs) inherited from the father. After transplacental transport, these alloantibodies can induce mild to severe thrombocytopenia of the fetus or newborn. In view of published results of a case series that did not report any therapeutic effect of maternal IVIG prophylaxis on fetal platelet counts [10] and lack of systematic evaluation of potential adverse effects of IVIG, we retrospectively evaluated the antenatal management of FNAIT in 12 subsequent patients that were treated according to a standardized local protocol.
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