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Fetal and Neonatal Alloimmune Thrombocytopenia: A Management Algorithm Based on Risk Stratification

Pacheco, Luis D. MD; Berkowitz, Richard L. MD; Moise, Kenneth J. Jr MD; Bussel, James B. MD; McFarland, Janice G. MD; Saade, George R. MD

doi: 10.1097/AOG.0b013e31823403f4
Current Commentary

Fetal and neonatal alloimmune thrombocytopenia constitutes the most common cause of severe thrombocytopenia in fetuses and neonates and of intracranial hemorrhage among term newborns. The cornerstone of therapy involves the use of steroids and intravenous immunoglobulins. Despite the risk of potentially devastating consequences to the fetus, fetal blood sampling has typically been used to document response to therapy. We propose a therapeutic algorithm based on risk stratification with individualized treatment optimization without the use of fetal blood sampling.

Management of fetal and neonatal alloimmune thrombocytopenia requires a priori risk stratification, and treatment should be tailored accordingly.

From the Divisions of Maternal Fetal Medicine and Surgical Critical Care, Departments of Obstetrics & Gynecology and Anesthesiology, The University of Texas Medical Branch at Galveston; Division of Maternal fetal Medicine, Department of Obstetrics & Gynecology, Columbia University Medical Center; Department of Obstetrics & Gynecology and Reproductive Sciences, University of Texas School of Medicine, Houston, Texas; Department of Obstetrics & Gynecology and Pediatrics, Weill Medical College of Cornell University, New York, New York; Division of Hematology-Oncology, Department of Medicine, Medical College of Wisconsin, and Platelet and Neutrophil Immunology Laboratory, BloodCenter of Wisconsin; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston.

The authors thank the Ob/Gyn Publication, Grant, and Media Support Department director and staff for editorial and graphic assistance, including R.G. McConnell, LeAnne Garcia, and Alan Sheffield.

Corresponding author: Luis D. Pacheco, MD, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX 77555-0587; e-mail: ldpachec@utmb.edu.

Financial Disclosure Dr. Bussel has received clinical research support from Amgen, Cangene, GlaxoSmithKline, Genzyme, IgG of America, Immunomedics, Ligand, Eisai, Inc., Shionogi, and Sysmex. He has participated in advisory boards for Amgen, GlaxoSmithKline, Ligand, Shionogi, and Eisai. He has had a 1-day consult with Portola. The other authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.