title: Intracranial hemorrhage in alloimmune thrombocytopenia: stratified management to prevent recurrence in the subsequent affected fetus.
abstract: OBJECTIVE
  We sought to prevent intracranial hemorrhage (ICH) through antenatal management of alloimmune thrombocytopenia.
  
  
  METHODS
  A total of 33 women (37 pregnancies) with alloimmune thrombocytopenia and ICH in a previous child were stratified according to the timing of the previous child's ICH: extremely high risk (HR) (n = 8) had ICH <28 weeks, very HR (n = 17) between 28-36 weeks, and HR (n = 12) in the perinatal period. Treatment was initiated at 12 weeks with intravenous immunoglobulin 1 or 2 g/kg/wk, and if the fetal platelet count by cordocentesis was <30,000/mL despite treatment, prednisone and/or more intravenous immunoglobulin were added.
  
  
  RESULTS
  Five of 37 fetuses suffered ICHs. Two ICHs had platelet counts >100,000/mL, and 1 was grade I. The other 2 ICHs were unequivocal treatment failures; both were grade III-IV and resulted in fetal demise.
  
  
  CONCLUSIONS
  These findings demonstrate the success of stratified treatment in these HR patients, which tailored interventions according to the timing of the sibling's ICH.
authors.affiliation: Department of Pediatrics and Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY 10065, USA. jbussel@med.cornell.edu
authors.forename: James B
authors.initials: JB
authors.lastname: Bussel
authors.forename: Richard L
authors.initials: RL
authors.lastname: Berkowitz
authors.forename: Crystal
authors.initials: C
authors.lastname: Hung
authors.forename: E Anders
authors.initials: EA
authors.lastname: Kolb
authors.forename: Megan
authors.initials: M
authors.lastname: Wissert
authors.forename: Andrea
authors.initials: A
authors.lastname: Primiani
authors.forename: Felicia W
authors.initials: FW
authors.lastname: Tsaur
authors.forename: Janice G
authors.initials: JG
authors.lastname: Macfarland
mesh_terms: D016824:Antigens, Human Platelet / Q000276:immunology; D015331:Cohort Studies; D017218:Cordocentesis; D005260:Female; D005312:Fetal Blood / Q000166:cytology; D005313:Fetal Death; D005315:Fetal Diseases / Q000097:blood* / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D039661:Integrin beta3; D020300:Intracranial Hemorrhages / Q000517:prevention & control*; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D016824:Antigens, Human Platelet; C061248:ITGB3 protein, human; D016756:Immunoglobulins, Intravenous; D039661:Integrin beta3