Prenatal diagnosis and management of bleeding disorders with fetal blood sampling

Daffos, F.; Forestier, F.; Kaplan, C.; Cox, Wendy L.

doi:10.1016/0002-9378(88)90098-1

Cited by 106 publications

(46 citation statements)

References 13 publications

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“…In very severe cases, some authors recommend in utero platelet transfusions [28,29]: several transfusions can be performed during pregnancy or only one just prior to the delivery.…”

Section: Management Of Subsequent Pregnanciesmentioning

confidence: 99%

Management of Fetal and Neonatal Alloimmune Thrombocytopenia

Forestier¹,

Hohlfeld

1998

Neonatology

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Fetal and neonatal thrombocytopenia can be induced by a maternal alloimmunization against fetal platelet antigens. Alloimmune thrombocytopenia occurs with an incidence of 1/1,000 livebirths and may present either with evidence of damage from a prenatal hemorrhage such as porencephaly or intrauterine death, or with active life-threatening bleeding during the neonatal period. It is due to the destruction of fetal platelets by alloantibodies reacting on specific antigenic sites. In Caucasians, the human platelet antigen 1a (HPA-1a) is the most frequently involved in alloimmune thrombocytopenias, accounting for 80–90% of the cases. Anti-HPA-5b is responsible for a further 5–15% of the cases. This article reviews the clinical aspects, the biological diagnosis and the management, including prenatal sampling and maternal therapy.

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“…In very severe cases, some authors recommend in utero platelet transfusions [28,29]: several transfusions can be performed during pregnancy or only one just prior to the delivery.…”

Section: Management Of Subsequent Pregnanciesmentioning

confidence: 99%

Management of Fetal and Neonatal Alloimmune Thrombocytopenia

Forestier¹,

Hohlfeld

1998

Neonatology

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“…Direct intravascular platelet transfu sions before delivery have been demon strated to reduce the risk of bleeding in fetuses with alloimmune thrombocytopenia [1], In erythroblastosis fetalis, survival rates of up to 72-81 % have been reported using straight or exchange transfusions in utero [2,3]. As opposed to traditional management with intraperitoneal transfusions, hemato crit may be monitored regularly and transfu sions begun when necessary as early as the 18th week.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Fetal Blood Volume for Computer-Assisted Management of in utero Transfusion

et al. 1988

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We performed 41 intravascular ultrasound-guided fetal transfusions in a total of 20 pregnancies with erythroblastosis fetalis or alloimmune thrombocytopenia. On the basis of this experience, we developed a computer-assisted procedure for determining the volume to be transfused, which provides an adequate final concentration. Fetal weight was estimated using ultrasound measurements. Fetoplacental blood volume was estimated from the regression line: fetoplacental volume (ml) = 1.046 + fetal weight (g) × 0.14. The volume to be transfused was calculated using the simple dilution formula:V_transfused = V_{fetoplacental}·(C_final –– C_initial)/C_transfused

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“…In case of fetal thrombocytopenia, which could appear later during gestation, the opti mal mode of antenatal treatment is currently under investigation. Studies have reported the benefit of maternal treatment: high-dose intravenous gamma globulin [11], corticoste roids [ 12] or a combination of both, or weekly in utero transfusions [13,14], Until now, there are no reports of direct medical fetal therapy. Fetal umbilical sampling is consid ered to be a safe procedure with an estimated fetal loss rate of 0.4%, but for other workers this risk is underestimated.…”

Section: Discussionmentioning

confidence: 99%

“…Trans fusions are technically similar to cord blood sampling and a selective immobilization of the fetus is obtained by fetal intravenous injection of vecuronium (0.1 mg/kg). It is advisable to use maternal platelets (obtained after centrifugation of whole blood) or platelet concentrate from a donor negative for the responsible antigen [ 12],…”

Section: Discussionmentioning

confidence: 99%

Alloimmune Thrombocytopenia: In utero Treatment by High Doses of Intravenous Gamma Globulins

et al. 1992

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The authors report successful in utero treatment by high doses of intravenous gamma globulins in a case of neonatal alloimmune thrombocytopenia. Early diagnosis allows an appropriate management: fetal blood sampling as early as 20 weeks of gestation; in case of fetal thrombocytopenia, treatment by intravenous gamma globulin (1.0 g/kg/b.w.) each week during 8 weeks or more; ultrasound screening of in utero hemorrhage, particularly intracranial hemorrhage; fetal blood sampling before delivery at term and in utero transfusion of platelet antigen negative in case of persistence of fetal thrombocytopenia.

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Prenatal diagnosis and management of bleeding disorders with fetal blood sampling

Cited by 106 publications

References 13 publications

Management of Fetal and Neonatal Alloimmune Thrombocytopenia

Management of Fetal and Neonatal Alloimmune Thrombocytopenia

Assessment of Fetal Blood Volume for Computer-Assisted Management of in utero Transfusion

Alloimmune Thrombocytopenia: In utero Treatment by High Doses of Intravenous Gamma Globulins

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