Fetal and neonatal alloimmune thrombocytopenia: a management algorithm based on risk stratification.
Fetal and neonatal alloimmune thrombocytopenia constitutes the most common cause of severe thrombocytopenia in fetuses and neonates and of intracranial hemorrhage among term newborns. The cornerstone of therapy involves the use of steroids and intravenous immunoglobulins. Despite the risk of potentially devastating consequences to the fetus, fetal blood sampling has typically been used to document response to therapy. We propose a therapeutic algorithm based on risk stratification with individualized treatment optimization without the use of fetal blood sampling.
From the Divisions of Maternal Fetal Medicine and Surgical Critical Care, Departments of Obstetrics & Gynecology and Anesthesiology, The University of Texas Medical Branch at Galveston; Division of Maternal fetal Medicine, Department of Obstetrics & Gynecology, Columbia University Medical Center; Department of Obstetrics & Gynecology and Reproductive Sciences, University of Texas School of Medicine, Houston, Texas; Department of Obstetrics & Gynecology and Pediatrics, Weill Medical College of Cornell University, New York, New York; Division of Hematology-Oncology, Department of Medicine, Medical College of Wisconsin, and Platelet and Neutrophil Immunology Laboratory, BloodCenter of Wisconsin; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston.
Luis D
LD
Pacheco
Richard L
RL
Berkowitz
Kenneth J
KJ
Moise
James B
JB
Bussel
Janice G
JG
McFarland
George R
GR
Saade
D000465:Algorithms; D001800:Blood Specimen Collection; D000075202:Contraindications; D036861:Delivery, Obstetric; D005260:Female; D005315:Fetal Diseases / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control; D058725:Peripartum Period; D011247:Pregnancy; D018570:Risk Assessment; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000628:therapy*