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Intracranial hemorrhage in alloimmune thrombocytopenia: stratified management to prevent recurrence in the subsequent affected fetus

Bussel, James B; Berkowitz, Richard L; Hung, Crystal; Kolb, E Anders; Wissert, Megan; Primiani, Andrea; Tsaur, Felicia W; Macfarland, Janice G
OBJECTIVE:We sought to prevent intracranial hemorrhage (ICH) through antenatal management of alloimmune thrombocytopenia. STUDY DESIGN/METHODS:A total of 33 women (37 pregnancies) with alloimmune thrombocytopenia and ICH in a previous child were stratified according to the timing of the previous child's ICH: extremely high risk (HR) (n = 8) had ICH <28 weeks, very HR (n = 17) between 28-36 weeks, and HR (n = 12) in the perinatal period. Treatment was initiated at 12 weeks with intravenous immunoglobulin 1 or 2 g/kg/wk, and if the fetal platelet count by cordocentesis was <30,000/mL despite treatment, prednisone and/or more intravenous immunoglobulin were added. RESULTS:Five of 37 fetuses suffered ICHs. Two ICHs had platelet counts >100,000/mL, and 1 was grade I. The other 2 ICHs were unequivocal treatment failures; both were grade III-IV and resulted in fetal demise. CONCLUSION/CONCLUSIONS:These findings demonstrate the success of stratified treatment in these HR patients, which tailored interventions according to the timing of the sibling's ICH.
PMID: 20494333
ISSN: 1097-6868
CID: 3015412

Intracranial Hemorrhage in Alloimmune Thrombocytopenia: Stratified Management to Prevent Recurrence in the Subsequent Affected Fetus [Meeting Abstract]

Bussel, James B.; Wissert, Megan; Tsaur, Felicia W.; Hung, Crystal; Primiani, Andrea
ISSN: 0006-4971
CID: 3015532