Antenatal noninvasive treatment of patients at risk for alloimmune thrombocytopenia without a history of intracranial hemorrhage

Yinon, Yoav; Spira, Maya; Solomon, Ofira; Weisz, Boaz; Chayen, Benjamin; Schiff, Eyal; Lipitz, Shlomo

doi:10.1016/j.ajog.2006.06.066

« Previous Next »American Journal of Obstetrics & Gynecology
Volume 195, Issue 4 , Pages 1153-1157, October 2006

Antenatal noninvasive treatment of patients at risk for alloimmune thrombocytopenia without a history of intracranial hemorrhage

Yoav Yinon, MD
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center
- Reprint requests: Yoav Yinon MD, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Maya Spira, MD
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center
Ofira Solomon, MD
- Department of Hematology, Amalia Biron Research Institute of Thrombosis and Hemostasis, the Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Boaz Weisz, MD
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center
Benjamin Chayen, MD
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center
Eyal Schiff, MD
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center
Shlomo Lipitz, MD
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center

Received 9 March 2006; received in revised form 31 May 2006; accepted 17 June 2006.

Objective

The purpose of this study was to evaluate noninvasive management of alloimmune thrombocytopenia that included only the blind administration of immunoglobulin.

Study design

Seventeen women with 30 pregnancies that were at risk of neonatal alloimmune thrombocytopenia were included. Except for 6 cases, in which the women refused treatment, 24 pregnancies were managed by the weekly administration of intravenous immunoglobulin without monitoring platelet count.

Results

The mean platelet count at birth after intravenous immunoglobulin treatment was 118,000/μL, compared with 25,000/μL among the 17 first affected infants and 24,000/μL among the 6 infants whose mothers refused treatment (P < .05). Only 8% of the treated fetuses had platelet counts of <30,000/μL at birth, compared with 70% of the untreated infants (P < .05). None of the treated and nontreated fetuses had an intracranial hemorrhage.

Conclusion

Noninvasive management of alloimmune thrombocytopenia that consists of only immunoglobulin administration is highly effective and seems safe in women without a history of fetal/neonatal intracranial hemorrhage.

Key words: Alloimmune thrombocytopenia, Noninvasive management, Intracranial hemorrhage, Immunoglobulin