| Management and outcome of 200 cases of fetomaternal alloimmune thrombocytopenia. | |
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MedLine Citation:
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PMID: 17465957 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Fetomaternal alloimmune thrombocytopenia (FMAIT) is the commonest cause of severe thrombocytopenia in term neonates but its management remains controversial. STUDY DESIGN AND METHODS: A 7-year prospective observational study of 200 cases of FMAIT evaluated the relationship between human platelet antigen (HPA) antibody specificity, clinical presentation, morbidity, mortality, and therapeutic interventions in the antenatal and postnatal period, with long-term follow-up of neonates with intracranial hemorrhage (ICH). RESULTS: In 1148 referrals for FMAIT, HPA antibodies were confirmed in 200 (17%). The commonest specificities were anti-HPA-1a, 150 (75%); anti-HPA-5b, 31 (15.5%); and anti-HPA-15b, 8 (4%). Of 123 (62%) cases (two sets of twins) with no previous history of FMAIT, intrauterine deaths occurred in 5: anti-HPA-1a alone, 3; in combination with anti-HPA-5b, 1; and anti-HPA-15b, 1. Of the 120 live neonates, 103 had severe thrombocytopenia and 17 (14%) developed ICH (anti-HPA-1a, 13; anti-HPA-5b, 3; anti-HPA-15b, 1). Postnatal care varied widely with 37 percent of neonates receiving random rather than HPA-1a and -5b-negative platelets. Of the remaining 77 cases with a history of FMAIT, 40 received intrauterine transfusions. Six (15%) of these fetuses died in utero and an additional 2 developed ICH postnatally. Of the 19 children with ICH, 1 (anti-HPA-15b) died on Day +1, and neurologic sequelae persist in 13 (mean follow-up, 2.5 years). CONCLUSION: HPA-1a antibodies are most commonly implicated in severe thrombocytopenia but HPA-5b and HPA-15b antibodies can also result in poor outcome. Postnatal transfusion management is extremely variable, and fetal transfusions are associated with significant morbidity and mortality. |
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Authors:
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Cedric Ghevaert; Kate Campbell; Jill Walton; Graham A Smith; Dave Allen; Lorna M Williamson; Willem H Ouwehand; Edmund Ranasinghe |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Transfusion Volume: 47 ISSN: 0041-1132 ISO Abbreviation: Transfusion Publication Date: 2007 May |
Date Detail:
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Created Date: 2007-04-30 Completed Date: 2007-09-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417360 Medline TA: Transfusion Country: United States |
Other Details:
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Languages: eng Pagination: 901-10 Citation Subset: IM |
Affiliation:
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National Blood Service Cambridge, Cambridge and Oxford, Department of Haematology, University of Cambridge, Cambridge, UK. cedric.ghevaert@nbs.nhs.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Antigens, Human Platelet
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immunology* Blood Transfusion, Intrauterine Female Fetal Blood / immunology Humans Immunity, Maternally-Acquired / immunology* Infant, Newborn Isoantibodies / blood, immunology Isoantigens / blood, immunology Maternal-Fetal Exchange / immunology Pregnancy Pregnancy Complications, Hematologic / therapy Prospective Studies Thrombocytopenia / immunology*, pathology, therapy |
| Chemical | |
Reg. No./Substance:
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0/1a alloantigen, human; 0/Antigens, Human Platelet; 0/Isoantibodies; 0/Isoantigens |
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