Prediction of the fetal status in noninvasive management of alloimmune thrombocytopenia.
Fetal/neonatal alloimmune thrombocytopenia is the most common cause of severe thrombocytopenia in the fetus and in an otherwise healthy newborn. To counter the consequences of severe fetal thrombocytopenia, antenatal therapies have been implemented. Predictive parameters for fetal severe thrombocytopenia are important for the development of noninvasive strategy and tailored intervention. We report here data concerning 239 pregnancies in 75 HPA-1bb women. Analysis of the index cases (diagnosis of fetal/neonatal alloimmune thrombocytopenia) did not show any significant correlation between the severity of the disease and the maternal genetic background (ABO blood group and HLA-DRB3 allele). Subsequent pregnancies were managed, and therapy effectiveness was evaluated. The highest mean newborn platelet count was observed for a combination of intravenous immunoglobulin and steroids (135 × 10⁹/L; 54 newborns) compared with intravenous immunoglobulin alone (89 × 10⁹/L; 27 newborns). The maternal anti-HPA-1a antibody concentration measured before any treatment and before 28 weeks of gestation was predictive of the fetal status. The weighted areas under curves of the maternal alloantibody concentrations were predictive of therapy response. To conclude, this large retrospective survey gives new insights on maternal predictive parameters for fetal status and therapy effectiveness allowing noninvasive strategies.
Platelet Immunology Unit, Institut National de Transfusion Sanguine, Paris, France.
Gerald
G
Bertrand
Moustapha
M
Drame
Corinne
C
Martageix
Cecile
C
Kaplan
D016824:Antigens, Human Platelet / Q000276:immunology; D036861:Delivery, Obstetric; D005260:Female; D005333:Fetus / Q000276:immunology* / Q000473:pathology*; D020073:Gravidity; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D039661:Integrin beta3; D020300:Intracranial Hemorrhages / Q000473:pathology; D007518:Isoantibodies / Q000276:immunology; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D035781:Siblings; D013256:Steroids / Q000627:therapeutic use; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
D016824:Antigens, Human Platelet; C061248:ITGB3 protein, human; D016756:Immunoglobulins, Intravenous; D039661:Integrin beta3; D007518:Isoantibodies; D013256:Steroids