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Postnatal intervention for the treatment of FNAIT: a systematic review

St. Michael's Hospital and The Hospital for Sick Children, University of Toronto, Toronto, Canada. bakerji@smh.ca. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Canada. Center for Innovation, Canadian Blood Services, Toronto, Canada. Weill Cornell Medicine, New York, NY, USA. NHS Blood & Transplant, Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals and University of Oxford, Oxford, UK. Institut fur Immunologie und Transfusionsmedizin, Universitatsmedizin Greifswald, Greifswald, Germany. University Hospital of Tuebingen, Tuebingen, Germany. Diagnostic and Therapeutic Services, NHS Blood and Transplant, Bristol, UK. University Health Network, University of Toronto, Toronto, Canada. Center for Innovation, Canadian Blood Services, Ottawa, Canada. McMaster Centre for Transfusion Research, McMaster University and Canadian Blood Services, Hamilton, Canada. Australian Red Cross Blood Service, Brisbane, QLD, Australia. BloodCenter of Brittany - (EFS) Etablissement Francais du Sang, Rennes, France. Finnmark Hospital Trust, Hammerfest, Norway. University Hospital of North Norway, Tromso, Norway. Retired and formerly Institut National de la Transfusion Sanguine, Paris, France. University and Regional Laboratories Region Skane, Lund, Sweden. Leiden University Medical Center, Leiden, The Netherlands. Royal Children's Hospital, Melbourne, Australia. Mount Sinai Hospital, Toronto, Canada. Division of Haematology/Oncology, CHU Sainte-Justine, University of Montreal, Montreal, Canada.

Journal of perinatology : official journal of the California Perinatal Association. 2019
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Abstract
OBJECTIVE Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality. STUDY DESIGN MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018. RESULT Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 x 10(9)/L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion. CONCLUSION Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine