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[Is a non-invasive management allowed for maternofetal alloimmune thrombocytopenia? Experience over a 10-year period]
P Deruelle1, B Wibaut, L Manessier
1Clinique de Gynécologie, d'Obstétrique et de Néonatologie, Hôpital Jeanne-de-Flandre, Centre Hospitalier Régional Universitaire (CHRU) de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France. p-deruelle@chru-lille.fr
Objectives:
Our purpose was to study a non-invasive management of fetomaternal alloimmune thrombocytopenia (FMAIT).
Patients And Methods:
Between 1996 and 2005, 18 women were treated. The population was divided into 2 groups: patients with a history of intracranial haemorrhage (ICH) in the older sibling received weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg per week) without initial cordocentesis whereas patients with a history of neonatal thrombocytopenia did not undergo any treatment.
Results:
All pregnancies with a previous FMAIT were monitored with serial ultrasound scans without cordecentesis. 15 patients had HPA-1, 2 HPA-3 and 1 HPA-5 immunizations. Weekly intravenous immunoglobulin therapy was administered in 5 patients with a history of ICH in the older sibling. Two of these delivered thrombocytopenic children; one had a platelet count < 50 x 10(9)/l. For the 13 women (one twin) who had a sibling with neonatal thrombocytopenia, 11/14 newborns had a platelet count < 50 x 10(9)/l. Predelivery fetal blood sampling were performed in 8/18 pregnancies. The neonatal periods of the 19 children were uncomplicated and no ICHs were observed.
Discussion And Conclusion:
Our results suggest that a non-invasive strategy avoiding serial cordocentesis may be an effective therapy in patients who are at risk of fetal and neonatal alloimmune thrombocytopenia.
