Retrospective comparison of maternal vs. HPA‐matched donor platelets for treatment of fetal alloimmune thrombocytopenia

Abstract

In fetal alloimmune thrombocytopenia (FAIT), transplacental maternal antibodies cause destruction of fetal platelets. FAIT is similar to fetal Rhesus haemolytic disease, but half of the affected fetuses are born to primiparous women. In 10-20% of cases, prenatal and perinatal intracranial haemorrhages are reported. Different therapeutic approaches have been described, including maternally administered high-dose intravenous immunoglobulin (high dose IVIG) without or with steroids or intrauterine transfusion (IUT) of compatible platelets. For the latter, the use of plasma-free maternal and donor platelets has been described, but a comparison of these two sources of platelets has not been reported. We retrospectively analyzed the clinical courses of cases with FAIT treated with IUT of either HPA-matched donor platelets or maternal platelets, done by a single team between 1990 and 1997. In 57 pregnancies, FAIT was treated by repeated IUT with either maternal (15 fetuses) or donor platelets (42 fetuses). There was no procedure-related fetal or neonatal loss. Platelets from both sources reliably raised the fetal platelet counts. Donor platelet preparations contained more platelets and yielded higher fetal post-transfusion platelet counts, but maternal platelets were clinically equally effective. Donor and maternal platelet concentrates are effective sources for the treatment of FAIT.