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

Department of Obstetrics, Leiden University Medical Center, Leiden, Netherlands; Blood Transfusion Medicine, University of Oxford; NHSBT and Oxford University Hospital, United Kingdom; Institute of Immunology and Transfusion Medicine, University Hospital Greifswald, Germany; Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Canada; Center for Clinical Transfusion Medicine, University of Tuebingen, Tuebingen, Germany; Diagnostic and Therapeutic Services, NHS Blood and Transplant, United Kingdom; Hospital for Sick Children, St. Michael's Hospital, Toronto, Canada. University Health Network, University of Toronto, Toronto, Canada; Center for Innovation, Canadian Blood Services, Toronto, Canada; Division of Haematology/Oncology, CHU Sainte-Justine, University of Montreal, Canada; Division of Hematology and Thromboembolism, McMaster University, Canada; Australian Red Cross Blood Services, Australia; Platelet Immunology Department, French Blood Services of Brittany (EFS), Rennes, France; Weill Cornell Medical College, United States. Department of Laboratory Medicine, Diagnostic Clinic, University Hospital of North Norway, Tromso, Norway and Finnmark Hospital Trust, Hammerfest, Norway; Formerly Institut National de la Transfusion Sanguine, France; Department of Clinical Immunology and Transfusion Medicine, Regional and University Laboratories Region Skane, Lund, Sweden; Department of Obstetrics, Leiden University Medical Center, Leiden, Netherlands; Fetal Medicine Unit, Mount Sinai Hospital, Toronto, Canada.

Blood. 2017;129((11):):1538-1547
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), and weekly maternal intravenous immunoglobulin infusion (IVIG), with or without additional corticosteroid therapy are common options, but the 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 twenty-two non-randomized 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 antenatal management strategy applied; FBS, IUPT or IVIG with/without corticosteroids. There is no consistent evidence for the value of adding steroids to IVIG. Fetal blood sampling or intrauterine platelet transfusion resulted in a relatively high complication rate, consisting mainly of preterm emergency cesarean section, 11% per treated pregnancy in all studies combined. Overall, non-invasive 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.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine