- 作者：James B. Bussel ; Richard L. Berkowitz ; Crystal Hung ; E. Anders Kolb ; Megan Wissert ; Andrea Primiani ; Felicia W. Tsaur ; Janice G. MacFarl
- 关键词：antiplatelet antibody ; fetal hematology ; intravenous gammaglobulin ; neonatal hematology ; platelets
- 刊名：American Journal of Obstetrics and Gynecology
- 出版年：2010
- 出版时间：August 2010
- 年：2010
- 卷：203
- 期：2
- 页码：135.e1-135.e14
- 全文大小：869 K
Objective
We sought to prevent intracranial hemorrhage (ICH) through antenatal management of alloimmune thrombocytopenia.Study Design
A total of 33 women (37 pregnancies) with alloimmune thrombocytopenia and ICH in a previous child were stratified according to the timing of the previous child's ICH: extremely high risk (HR) (n = 8) had ICH <28 weeks, very HR (n = 17) between 28-36 weeks, and HR (n = 12) in the perinatal period. Treatment was initiated at 12 weeks with intravenous immunoglobulin 1 or 2 g/kg/wk, and if the fetal platelet count by cordocentesis was <30,000/mL despite treatment, prednisone and/or more intravenous immunoglobulin were added.
Results
Five of 37 fetuses suffered ICHs. Two ICHs had platelet counts >100,000/mL, and 1 was grade I. The other 2 ICHs were unequivocal treatment failures; both were grade III-IV and resulted in fetal demise.
Conclusion
These findings demonstrate the success of stratified treatment in these HR patients, which tailored interventions according to the timing of the sibling's ICH.