Serial Aggressive Platelet Transfusion for Fetal Alloimmune Thrombocytopenia: Platelet Dynamics and Perinatal Outcome

Am J Obstet Gynecol. 2002 Apr;186(4):826-31. doi: 10.1067/mob.2002.122140.

Abstract

Objectives: Our purpose was to describe the fetal loss rate and platelet dynamics in fetal alloimmune thrombocytopenia managed by serial platelet transfusions.

Methods: Retrospective analysis over 10 years of consecutive pregnancies affected by fetal alloimmune thrombocytopenia requiring in utero platelet transfusions.

Results: There were 2 perinatal losses in 12 pregnancies managed by 84 platelet transfusions. One was obviously procedure related from exsanguination despite platelet transfusion. The attributable procedure related fetal loss rate was 1.2% per procedure but 8.3% per pregnancy. The median rate of fall in fetal platelet count per day after transfusion was lower at the placental cord insertion (n = 54) 40.5 x 10(9)/L (range, 5.4-96.1 x 10(9)/L) compared with that at the intrahepatic vein (n = 30) 50.9 x 10(9)/L,(range, 29.5-91 x 10(9)/L) (P = .0009).

Conclusion: Pooling our results with those previously published yields a cumulative risk of serial weekly transfusions of approximately 6% per pregnancy, indicating the need for development of less invasive approaches.

MeSH terms

  • Blood Specimen Collection / methods
  • Female
  • Fetal Death
  • Fetal Diseases / therapy*
  • Gestational Age
  • Hepatic Veins / embryology
  • Humans
  • Isoantibodies / immunology*
  • Platelet Count
  • Platelet Transfusion*
  • Pregnancy
  • Retrospective Studies
  • Thrombocytopenia / immunology*
  • Thrombocytopenia / mortality
  • Thrombocytopenia / therapy*
  • Umbilical Veins

Substances

  • Isoantibodies