Feto-maternal alloimmune thrombocytopenia: a literature review and statistical analysis.
Exploring prognostic factors that determine outcomes in fetomaternal alloimmune thrombocytopenia (FMAIT), a search of Medline was performed covering the years 1966 to April 1998. 376 articles were collected and reviewed; 140 articles contained the case histories of 297 mothers and 433 pregnancies that fulfilled entry criteria. More than 30 data variables were sought from these cases. The data were analysed using SPSS and Arcus Quickstat Biomedical. Nineteen different antigen incompatibilities were documented, the majority being human platelet antigen (HPA)-1a (77.3%), HPA-3a (3.5%) and HPA-5b (3.5%). The relative risk reduction (RRR) in mortality with any intervention was 57% (0.19-0.77) p = 0.009. Treatment of HPA-1a (PlA1) pregnancies with intravenous immunoglobulin (IVIG) increased the likelihood of a neurologically normal outcome, relative risk (RR) 1.68, confidence interval (1.3-2.2) p = 0.0003. Treatment of HPA-1a (PlA1) pregnancies with only antenatal complementary platelet transfusions increased the likelihood of a neurologically normal outcome, RR 1.63 (1.1-2.1) p = 0.01. Despite reviews of more than 400 cases of FMAIT, few prognostic variables are identifiable. Although IVIG appears to reduce the risk of intracranial haemorrhage (ICH), the dosage and timing of IVIG treatment was varied. This study highlights the need for standardised and directed research.
Spencer
J A
JA
Monash University, Melbourne, Victoria, Australia.
Burrows
R F
RF
D016824:Antigens, Human Platelet / Q000276:immunology*; D005260:Female; D005315:Fetal Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D005331:Fetomaternal Transfusion / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D039661:Integrin beta3; D009017:Morbidity; D010976:Platelet Count; D017713:Platelet Transfusion; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D016896:Treatment Outcome
C044561:3a alloantigen, human; C055973:5b alloantigen, human; D016824:Antigens, Human Platelet; C061248:ITGB3 protein, human; D016756:Immunoglobulins, Intravenous; D039661:Integrin beta3