Antenatal Management of Severe Feto-Maternal Alloimmune Thrombocytopenia: HLA Incompatibility May Affect Responses to Fetal Platelet Transfusions

摘要: In feto-maternal alloimmune thrombocytopenia (FMAIT), severe hemorrhage, particularly intracranial haemorrhage (ICH), may occur before delivery. Management strategies to prevent ICH in high-risk pregnancies include maternal administration of intravenous Ig with or without steroids and fetal platelet transfusions. This report describes a patient who lost three fetuses because FMAIT due anti- HPA-1a. occurred earlier successive (at 28, 19, 16 weeks gestation) despite treatment from 14 gestation the third pregnancy. The fourth pregnancy was managed by administering weekly intraperitoneal injections fetus 12 18 gestation. At weeks, there no evidence ICH, but count only x 10(9)/L. Serial transfusions were started, poor responses immune destruction transfused platelets HLA antibodies. There improved prepared mother HLA- compatible HPA-1a-negative donors. 35 gestation, normal infant delivered Caesarean section after 20 prolonged baby for 15 birth, probably transfer HPA-1a antibodies unwashed platelets. optimal management likely be severely affected is still evolving. Intensive successful this case, outcome cannot guaranteed cases. first time that incompatibility has been found complicate transfusion therapy.