Intracranial hemorrhage in alloimmune thrombocytopenia: stratified management to prevent recurrence in the subsequent affected fetus.
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.
Bussel
James B
JB
Department of Pediatrics and Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY 10065, USA. jbussel@med.cornell.edu
Berkowitz
Richard L
RL
Hung
Crystal
C
Kolb
E Anders
EA
Wissert
Megan
M
Primiani
Andrea
A
Tsaur
Felicia W
FW
Macfarland
Janice G
JG
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
D016824:Antigens, Human Platelet; C061248:ITGB3 protein, human; D016756:Immunoglobulins, Intravenous; D039661:Integrin beta3