title: Antenatal management in fetal and neonatal alloimmune thrombocytopenia: a systematic review.
abstract: Several strategies can be used to manage fetal or neonatal alloimmune thrombocytopenia (FNAIT) in subsequent pregnancies. Serial fetal blood sampling (FBS) and intrauterine platelet transfusions (IUPT), as well as weekly maternal IV immunoglobulin infusion (IVIG), with or without additional corticosteroid therapy, are common options, but optimal management has not been determined. The aim of this systematic review was to assess antenatal treatment strategies for FNAIT. Four randomized controlled trials and 22 nonrandomized studies were included. Pooling of results was not possible due to considerable heterogeneity. Most studies found comparable outcomes regarding the occurrence of intracranial hemorrhage, regardless of the antenatal management strategy applied; FBS, IUPT, or IVIG with or without corticosteroids. There is no consistent evidence for the value of adding steroids to IVIG. FBS or IUPT resulted in a relatively high complication rate (consisting mainly of preterm emergency cesarean section) of 11% per treated pregnancy in all studies combined. Overall, noninvasive management in pregnant mothers who have had a previous neonate with FNAIT is effective without the relatively high rate of adverse outcomes seen with invasive strategies. This systematic review suggests that first-line antenatal management in FNAIT is weekly IVIG administration, with or without the addition of corticosteroids.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Dian
authors.initials: D
authors.lastname: Winkelhorst
authors.affiliation: Blood Transfusion Medicine, Oxford University Hospitals, and.|NHS Blood and Transplant, University of Oxford, Oxford, United Kingdom.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
authors.affiliation: Institute of Immunology and Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
authors.affiliation: Department of Medicine, and.|Department of Obstetric Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehata
authors.affiliation: Institute of Immunology and Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany.|Center for Clinical Transfusion Medicine, University of Tuebingen, Tuebingen, Germany.
authors.forename: Taman
authors.initials: T
authors.lastname: Bakchoul
authors.affiliation: Diagnostic and Therapeutic Services, NHS Blood and Transplant, Oxford, United Kingdom.
authors.forename: Edwin
authors.initials: E
authors.lastname: Massey
authors.affiliation: Hospital for Sick Children, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Jillian
authors.initials: J
authors.lastname: Baker
authors.affiliation: University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Lani
authors.initials: L
authors.lastname: Lieberman
authors.affiliation: Center for Innovation, Canadian Blood Services, Toronto, ON, Canada.
authors.forename: Susano
authors.initials: S
authors.lastname: Tanael
authors.affiliation: Division of Hematology-Oncology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Hume
authors.affiliation: Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Arnold
authors.affiliation: Australian Red Cross Blood Service, Brisbane, QLD, Australia.
authors.forename: Shoma
authors.initials: S
authors.lastname: Baidya
authors.affiliation: Platelet Immunology Department, French Blood Services of Brittany, Rennes, France.
authors.forename: Gerald
authors.initials: G
authors.lastname: Bertrand
authors.affiliation: Weill Cornell Medical College, Cornell University, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Bussel
authors.affiliation: Department of Laboratory Medicine, Diagnostic Clinic, University Hospital of North Norway, Tromsø, Norway.|Finnmark Hospital Trust, Hammerfest, Norway.
authors.forename: Mette
authors.initials: M
authors.lastname: Kjaer
authors.affiliation: Institut National de la Transfusion Sanguine, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Kaplan
authors.affiliation: Department of Clinical Immunology and Transfusion Medicine, Regional and University Laboratories, Region Skåne, Lund, Sweden; and.
authors.forename: Jens
authors.initials: J
authors.lastname: Kjeldsen-Kragh
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.affiliation: Fetal Medicine Unit, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000517:prevention & control; D009035:Mothers; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D013256:Steroids / Q000627:therapeutic use; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous; D013256:Steroids