Intravenous immunoglobulins without initial and follow-up cordocentesis in alloimmune fetal and neonatal thrombocytopenia at high risk for intracranial hemorrhage.
OBJECTIVE
To report on a less invasive treatment strategy in alloimmune fetal and neonatal thrombocytopenia (FNAIT) at high risk for either in utero or neonatal intracranial hemorrhage (ICH).


METHODS
In 7 pregnancies, with a history of ICH in the older sibling, weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg) without initial cordocentesis was started at a median gestational age of 16 weeks.


RESULTS
In 4 pregnancies cordocentesis was avoided. One predelivery cordocentesis with platelet transfusion was performed in 3 further cases. Although none of the cases had a platelet count of >50 x 10(9)/l at cordocentesis, predelivery or birth, no ICHs were observed. The neonatal periods of the infants were uncomplicated.


CONCLUSIONS
IVIG treatment alone might be considered in patients with both severe platelet alloimmunization and an increased risk for morbidity and mortality at cordocentesis.
Kanhai
Humphrey H H
HH
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. h.h.h.kanhai@lumc.nl
van den Akker
Eline S A
ES
Walther
Frans J
FJ
Brand
Anneke
A
D016824:Antigens, Human Platelet / Q000276:immunology; D017218:Cordocentesis; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors; D013921:Thrombocytopenia / Q000150:complications / Q000188:drug therapy* / Q000276:immunology
D016824:Antigens, Human Platelet; D016756:Immunoglobulins, Intravenous