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

Winkelhorst, Dian; Murphy, Michael F.; Greinacher, Andreas; Shehata, Nadine; Bakchoul, Taman; Massey, Edwin; Baker, Jillian; Lieberman, Lani; Tanael, Susano and Hume, Heather, et al. (2017) In Blood 129(11). p.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), 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... (More)

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.

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published
subject
keywords
thrombocytopenia, neonatal, fetal abnormalities, Antenatal management
in
Blood
volume
129
issue
11
pages
10 pages
publisher
American Society of Hematology
external identifiers
  • scopus:85015814415
  • pmid:28130210
  • wos:000397294700021
ISSN
0006-4971
DOI
10.1182/blood-2016-10-739656
language
English
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yes
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ab70d06a-ec6e-4fb0-b384-96c2fc10a288
date added to LUP
2017-04-23 14:29:43
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2017-09-18 13:32:57
@article{ab70d06a-ec6e-4fb0-b384-96c2fc10a288,
  abstract     = {<p>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.</p>},
  author       = {Winkelhorst, Dian and Murphy, Michael F. and Greinacher, Andreas and Shehata, Nadine and Bakchoul, Taman and Massey, Edwin and Baker, Jillian and Lieberman, Lani and Tanael, Susano and Hume, Heather and Arnold, Donald M. and Baidya, Shoma and Bertrand, Gerald and Bussel, James B. and Kjaer, Mette and Kaplan, Cécile and Kjeldsen-Kragh, Jens and Oepkes, Dick and Ryan, Greg},
  issn         = {0006-4971},
  keyword      = {thrombocytopenia,neonatal,fetal abnormalities,Antenatal management},
  language     = {eng},
  month        = {03},
  number       = {11},
  pages        = {1538--1547},
  publisher    = {American Society of Hematology},
  series       = {Blood},
  title        = {Antenatal management in fetal and neonatal alloimmune thrombocytopenia : A systematic review},
  url          = {http://dx.doi.org/10.1182/blood-2016-10-739656},
  volume       = {129},
  year         = {2017},
}