Document Detail

Screening in pregnancy for fetal or neonatal alloimmune thrombocytopenia: systematic review.
MedLine Citation:
PMID:  20618318     Owner:  NLM     Status:  MEDLINE    
BACKGROUND:   Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a potentially devastating disease, which may lead to intracranial haemorrhage (ICH), with neurological damage as a consequence. In the absence of screening, FNAIT is only diagnosed after bleeding symptoms, with preventive options limited to a next pregnancy.
OBJECTIVES:   To estimate the population incidence of FNAIT and its consequences to prepare for study design of a screening programme.
SEARCH STRATEGY:   An electronic literature search using MEDLINE, EMBASE and Cochrane database, and references of retrieved articles. No language restrictions were applied.
SELECTION CRITERIA:   Prospective studies on screening for human platelet antigen 1a (HPA-1a) alloimmunisation in low-risk pregnant women.
DATA COLLECTION AND ANALYSIS:   Two reviewers independently assessed studies for inclusion and extracted data. Main outcome data were prevalence of HPA-1a negativity, HPA-1a immunisation, platelet count at birth and perinatal ICH. We aimed to compare outcome with and without intervention.
MAIN RESULTS:   HPA-1a alloimmunisation occurred in 294/3028 (9.7%) pregnancies at risk. Severe FNAIT occurred in 71/227 (31%) immunised pregnancies, with perinatal ICH in 7/71 (10%). True natural history data were not found because interventions were performed in most screen-positive women.
AUTHORS' CONCLUSIONS:   Screening for HPA-1a alloimmunisation detects about two cases in 1000 pregnancies. The calculated risk for perinatal ICH of 10% in pregnancies with severe FNAIT is an underestimation because studies without interventions were lacking. Screening of all pregnancies together with effective antenatal treatment such as intravenous immunoglobulin may reduce the mortality and morbidity associated with FNAIT.
M M Kamphuis; N Paridaans; L Porcelijn; M De Haas; C E Van Der Schoot; A Brand; G J Bonsel; D Oepkes
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  117     ISSN:  1471-0528     ISO Abbreviation:  BJOG     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  1335-43     Citation Subset:  AIM; IM    
Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
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MeSH Terms
Antigens, Human Platelet / blood*
HLA-DR Antigens / blood
Infant Mortality
Infant, Newborn
Perinatal Mortality
Pregnancy Outcome
Pregnancy, High-Risk
Prenatal Diagnosis / methods*
Prospective Studies
Thrombocytopenia, Neonatal Alloimmune / diagnosis*
Reg. No./Substance:
0/1a alloantigen, human; 0/Antigens, Human Platelet; 0/HLA-DR Antigens; 0/HLA-DRB3

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