Document Detail


Alloimmune thrombocytopenia: state of the art 2006.
MedLine Citation:
PMID:  16875656     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In alloimmune thrombocytopenia maternal immunoglobulin G anti-platelet alloantibodies cross the placenta and cause fetal thrombocytopenia. The diagnosis requires laboratory demonstration of incompatibility between a maternal and paternal platelet alloantigen, and detection of maternal antibody to the discordant paternal alloantigen. This disorder should be treated in utero because of its propensity to cause fetal intracranial bleeding. Administration of intravenous immunoglobulin 1 gm/kg/wk to the mother is successful in substantially raising the platelet count in many fetuses, but this is most successful if the count is >20,000/mL3 at the time that the therapy is initiated. The addition of prednisone administered daily to the mother and/or increasing the dose of intravenous immunoglobulin has a therapeutic benefit in cases that have failed to respond to initial therapy with intravenous immunoglobulin alone. The only reliable noninvasive indicator of the potential for severe fetal thrombocytopenia is a history of an antenatal intracranial hemorrhage in a prior affected sibling. Because fetal blood sampling to determine the fetal platelet count may be associated with significant fetal morbidity, attempts are being made to derive a rational, non-invasive, stratified approach to patient-specific therapy of this disorder in affected pregnancies.
Authors:
Richard L Berkowitz; James B Bussel; Janice G McFarland
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Publication Detail:
Type:  Journal Article; Review     Date:  2006-07-26
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  195     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-26     Completed Date:  2006-10-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  907-13     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, New York, NY 10032, USA. rb2212@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Antigens, Human Platelet / immunology*
Blood Specimen Collection
Cerebral Hemorrhage / etiology
Clinical Trials as Topic
Female
Fetal Blood
Fetal Diseases / diagnosis,  etiology,  therapy*
HLA Antigens / immunology
Humans
Immunoglobulins, Intravenous / therapeutic use
Platelet Transfusion
Pregnancy
Thrombocytopenia / diagnosis,  etiology,  therapy*
Chemical
Reg. No./Substance:
0/1a alloantigen, human; 0/Antigens, Human Platelet; 0/HLA Antigens; 0/Immunoglobulins, Intravenous; 0/human platelet antigen 1b

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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