Antenatal management in fetal and neonatal alloimmune thrombocytopenia: A systematic review

Research output: Contribution to journalReview article

Abstract

Several strategies can be used to manage fetal or neonatal alloimmune thrombocytopenia (FNAIT) in subsequent pregnancies. Serial fetal blood sampling (FBS) and intrauterine platelet transfusions (IUPT), as well as weekly maternal IV immunoglobulin infusion (IVIG), with or without additional corticosteroid therapy, are common options, but optimal management has not been determined. The aim of this systematic review was to assess antenatal treatment strategies for FNAIT. Four randomized controlled trials and 22 nonrandomized studies were included. Pooling of results was not possible due to considerable heterogeneity. Most studies found comparable outcomes regarding the occurrence of intracranial hemorrhage, regardless of the antenatal management strategy applied; FBS, IUPT, or IVIG with or without corticosteroids. There is no consistent evidence for the value of adding steroids to IVIG. FBS or IUPT resulted in a relatively high complication rate (consisting mainly of preterm emergency cesarean section) of 11% per treated pregnancy in all studies combined. Overall, noninvasive management in pregnant mothers who have had a previous neonate with FNAIT is effective without the relatively high rate of adverse outcomes seen with invasive strategies. This systematic review suggests that first-line antenatal management in FNAIT is weekly IVIG administration, with or without the addition of corticosteroids.

Details

Authors
  • Dian Winkelhorst
  • Michael F. Murphy
  • Andreas Greinacher
  • Nadine Shehata
  • Taman Bakchoul
  • Edwin Massey
  • Jillian Baker
  • Lani Lieberman
  • Susano Tanael
  • Heather Hume
  • Donald M. Arnold
  • Shoma Baidya
  • Gerald Bertrand
  • James B. Bussel
  • Mette Kjaer
  • Cécile Kaplan
  • Jens Kjeldsen-Kragh
  • Dick Oepkes
  • Greg Ryan
Organisations
External organisations
  • Leiden University Medical Centre
  • University of Oxford
  • University Hospital Greifswald
  • University of Cincinnati
  • Mount Sinai Hospital of University of Toronto
  • University of Tübingen
  • National Health Service Blood and Transplant
  • Saint Michael's Hospital
  • University of Toronto
  • Canadian Blood Services
  • University Of Quebec In Montreal
  • McMaster University
  • Australian Red Cross Blood Service
  • French Blood Services of Brittany
  • Weill Cornell Medical College
  • University Hospital of North Norway
  • Finnmark Hospital Trust
  • Institut National de la Transfusion Sanguine (INTS)
  • Regional Laboratories Region Skåne
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine

Keywords

  • thrombocytopenia, neonatal, fetal abnormalities, Antenatal management
Original languageEnglish
Pages (from-to)1538-1547
Number of pages10
JournalBlood
Volume129
Issue number11
Publication statusPublished - 2017 Mar 16
Publication categoryResearch
Peer-reviewedYes