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

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.

Murphy, Michael F.University of Oxford (author)
Greinacher, AndreasUniversity Hospital Greifswald (author)
Shehata, NadineMount Sinai Hospital of University of Toronto,University of Cincinnati (author)
Bakchoul, TamanUniversity Hospital Greifswald,University of Tübingen (author)
Massey, EdwinNational Health Service Blood and Transplant (author)
Baker, JillianSaint Michael's Hospital (author)
Lieberman, LaniUniversity of Toronto (author)
Tanael, SusanoCanadian Blood Services (author)
Hume, HeatherUniversity Of Quebec In Montreal (author)
Arnold, Donald M.McMaster University (author)
Baidya, ShomaAustralian Red Cross Blood Service (author)
Bertrand, GeraldFrench Blood Services of Brittany (author)
Bussel, James B.Weill Cornell Medical College (author)
Kjaer, MetteFinnmark Hospital Trust,University Hospital of North Norway (author)
Kaplan, CécileInstitut National de la Transfusion Sanguine (INTS) (author)
Kjeldsen-Kragh, JensLund University,Lunds universitet,Avdelningen för hematologi och transfusionsmedicin,Institutionen för laboratoriemedicin,Medicinska fakulteten,Division of Hematology and Transfusion Medicine,Department of Laboratory Medicine,Faculty of Medicine,Regional Laboratories Region Skåne(Swepub:lu)med-jks (author)
Oepkes, DickLeiden University Medical Centre (author)
Ryan, GregMount Sinai Hospital of University of Toronto (author)
Leiden University Medical CentreUniversity of Oxford (creator_code:org_t)

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Obstetrics Gynae ...

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.