Advances in the management of alloimmune thrombocytopenia

There have been considerable advances in the clinical and laboratory diagnosis of alloimmune thrombocytopenia (AIT), and its postnatal and antenatal management. The antenatal management of AIT has been particularly problematic, because severe haemorrhage occurs as early as 16 weeks gestation and there is no non-invasive investigation that reliably predicts the severity of AIT in utero. The strategies for antenatal treatment have included the use of serial platelet transfusions that, while effective, are invasive and associated with significant morbidity and mortality. Maternal therapy involving the administration of intravenous immunoglobulin and/or steroids is also effective and associated with fewer risks to the fetus. Significant recent progress has involved refinement of maternal treatment, stratifying it according to the likely severity of AIT based on the history in previous pregnancies. However, the ideal antenatal treatment, which is effective without causing significant side-effects to the mother or fetus, has yet to be determined, and further clinical trials are needed.