Fetal alloimmune thrombocytopenia and maternal intravenous immunoglobulin infusion.
BACKGROUND
Different therapeutic approaches have been used in fetal-neonatal alloimmune thrombocytopenia, but many centers administer immunoglobulin G infusions to the pregnant woman. We studied the effect of maternal antenatal immunoglobulin infusions on fetal platelet counts in pregnancies with fetal alloimmune thrombocytopenia.


METHODS
We retrospectively analyzed the clinical courses of fetuses with fetal alloimmune thrombocytopenia whose mothers were treated with immunoglobulin G infusions in a single center between 1999 and 2005. In a center-specific protocol, weekly maternal immunoglobulin G infusions were given to 25 pregnant women with previously affected neonates and four women with strong platelet antibodies, but no previous history of fetal alloimmune thrombocytopenia; before each infusion diagnostic fetal blood sampling was performed to determine fetal platelet counts and immunoglobulin G levels.


RESULTS
There were 30 fetuses with fetal alloimmune thrombocytopenia, confirmed by initial fetal blood sampling showing fetal platelet counts between 4×10(9)/L and 130×10(9)/L and antibody-coated fetal platelets using a glycoprotein specific assay. Despite weekly antenatal maternal immunoglobulin G infusions fetal platelet counts did not change significantly. Maternal and fetal immunoglobulin G levels, measured before every infusion, increased significantly with the number of maternal immunoglobulin G infusions.


CONCLUSIONS
In this group of fetuses with fetal alloimmune thrombocytopenia no consistent increase of fetal platelets was achieved as a result of regular maternal immunoglobulin G infusions.
Clinical Hemostaseology and Transfusion Medicine University Hospital Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany. giers@uni-duesseldorf.de
Günther
G
Giers
Folker
F
Wenzel
Markus
M
Stockschläder
Regina
R
Riethmacher
Horst
H
Lorenz
Boris
B
Tutschek
D000328:Adult; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D010976:Platelet Count; D011247:Pregnancy; D012189:Retrospective Studies; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000097:blood / Q000188:drug therapy*
D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors