Initial fetal platelet counts predict the response to intravenous gammaglobulin therapy in fetuses that are affected by PLA1 incompatibility

Article Abstract:

Fetuses with alloimmune thrombocytopenia are most likely to respond to treatment with intravenous gammaglobulin therapy if their initial platelet count is greater than 20,000 per microliter. Doctors can therefore minimize the use of fetal blood sampling in these fetuses.

Care and treatment, Fetal diseases

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Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentisis

Article Abstract:

Fetuses with blood clotting disorders are at increased risk from bleeding to death from cordocentesis. Cordocentesis is a procedure where a blood sample is taken from the fetal umbilical cord by passing a needle through the mother's abdomen. Five fetuses with alloimmune thrombocytopenia, a disease in which the mother's immune system attacks fetal platelets, a blood component responsible for clotting, bled to death after cordocentesis. They were compared with 44 fetuses with the same disease who survived the procedure. The mean platelet count among fetuses who died was 6 versus 33 X 10 to the ninth power per liter among surviving fetuses. Fetuses who died were also more likely to have a sibling with the disease from a prior pregnancy who had a brain hemorrhage before birth. It is strongly recommended that fetuses with platelet counts of 50 or less at the time of cordocentesis receive a blood transfusion before withdrawing the sampling needle.

Complications and side effects, Fetus, Cordocentesis

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Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: a randomized trial of the addition of low-dose steroid to intravenous gamma-globulin

Article Abstract:

Fetuses with very low platelet counts may benefit from intravenous gamma-globulin treatment. Researchers compared the effects of intravenous gamma-globulin treatment with or without dexamethasone or prednisone administered to 54 pregnant women whose fetuses had low platelet counts. Weekly treatments of intravenous gamma-globulin significantly increased platelet counts from time of diagnosis until birth. None of the treated fetuses experienced brain hemorrhage, which can occur in up to 50% of fetuses with low platelet counts. The addition of dexamethasone to treatment did not enhance the platelet count. The addition of prednisone raised platelet counts in half of the fetuses who did not respond to initial treatments. A noninvasive method of determining platelet counts would be useful.

Evaluation, Drug therapy, Prednisone, Dexamethasone

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