Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?

Radder, Celine M.; Brand, Anneke; Kanhai, Humphrey H.H.

doi:10.1046/j.1423-0410.2003.00302.x

Cited by 103 publications

(94 citation statements)

References 67 publications

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“…The same trend was found in another review study, in which only 15% of in utero ICH cases occurred before 24 weeks [28]. We have identified 16 cases of ICH reported in the literature, where the bleeding was diagnosed in utero and the gestational age at the time of diagnosis was stated.…”

Section: Perspectivesupporting

confidence: 78%

“…In one review of retrospective FNAIT studies and case reports, 81% of ICH cases were detected antenatally [5] while another literature review found that 51% of ICH cases occurred in utero [28]. In this last review, in utero ICH cases were mainly diagnosed after 30 weeks gestation, and only 14% were detected before 20 weeks of gestation…”

Section: Occurrence Of Intracranial Hemorrhagementioning

confidence: 95%

“…Two literature studies summarized data on untreated FNAIT cases and found an 80% recurrence rate for ICH [5,28]. However, the authors stated that this might be an overestimate since reports of less-severe cases of FNAIT are likely to be under-represented in the literature.…”

Section: Obstetric History Of Fnait As a Predictor Of Severitymentioning

confidence: 99%

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Reconsidering fetal and neonatal alloimmune thrombocytopenia with a focus on screening and prevention

Skogen

Killie

Kjeldsen‐Kragh

et al. 2010

Expert Review of Hematology

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Section: Perspectivesupporting

confidence: 78%

Section: Occurrence Of Intracranial Hemorrhagementioning

confidence: 95%

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Reconsidering fetal and neonatal alloimmune thrombocytopenia with a focus on screening and prevention

Skogen

Killie

Kjeldsen‐Kragh

et al. 2010

Expert Review of Hematology

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“…13,14 However, true natural history information is lacking. Our previous review on screening studies performed in pregnant women at risk for FNAIT 5 showed that screen-positive cases and those already known to have alloantibodies against fetal platelets received, understandably, various types of interventions.…”

Section: Perinatal Mortality and Neonatal Morbiditymentioning

confidence: 99%

Incidence and Consequences of Neonatal Alloimmune Thrombocytopenia: A Systematic Review

Kamphuis¹,

Paridaans²,

Porcelijn

et al. 2014

Pediatrics

105

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BACKGROUND: Neonatal alloimmune thrombocytopenia (NAIT) is a potentially devastating disease that may lead to intracranial hemorrhage in the fetus or neonate, often with death or major neurologic damage. There are no routine screening programs for NAIT, preventive measures are taken only in a subsequent pregnancy. To estimate the population incidence of NAIT and its consequences, we conducted a review of the literature. Our results may aid in the design of a screening program.METHODS: An electronic literature search included Medline, Embase, Cochrane database and references of retrieved articles. Eligible for inclusion were all prospective studies aimed at diagnosing NAIT in a general, nonselected newborn population, with sufficient information on platelet count at birth, bleeding complications, and treatment. Titles and abstracts were reviewed, followed by review of full text publications. Studies were independently assessed by 2 reviewers for methodologic quality. Disagreements were resolved by consensus, including a third reviewer.

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“…La probabilidad de recurrencia de la TFNA en las siguientes gestaciones es muy elevada (hasta el 79%), sobre todo si en la gestación anterior se produjo HIC 13 . Este riesgo puede descender hasta un 7% si la historia de TFNA no estuvo acompañada de HIC.…”

Section: Discussionunclassified

Trombocitopenia fetal/neonatal aloinmune: Revisión a propósito de un caso

Wilhelmi¹,

Aranguren²,

Muñíz³

et al. 2008

Anales Sis San Navarra

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RESUMENLa trombocitopenia fetal/neonatal aloinmune (TFNA) es la causa más frecuente de trombocitopenia grave en el recién nacido. Es un proceso agudo donde las plaquetas fetales son destruidas durante la gestación por un anticuerpo de tipo IgG presente en la madre aloinmunizada. En la raza caucási-ca, tiene especificidad frente al antígeno específico plaquetar HPA-1a en más del 80% de los casos. La hemorragia intracraneal, que ocurre hasta en un 30%, es la complicación más grave, con un 10% de mortalidad y un 20% de secuelas neurológicas irreversibles. El alto riesgo de repetición de hemorragia grave en futuras gestaciones obliga a plantearse profilaxis o tratamiento antenatal. El diagnóstico precoz puede permitir administrar un tratamiento eficaz basado en la transfusión de plaquetas de fenotipo HPA compatible o de inmunoglobulinas endovenosas.Presentamos el caso de una gestante de 27 años, que en la semana 35 de su segunda gestación fue diagnosticada por ecografía de hidrocefalia fetal bilateral. En la cesárea realizada en la semana 36, el neonato presentó hematomas en hombro y glúteo izquierdos, macrocefalia con fontanelas a tensión y salida de líquido cefalorraquídeo hemorrágico tras la colocación de un catéter de derivación externo. El hemograma reveló trombocitopenia grave (9 x 10 9 /L). Ante sospecha clínica de TFNA, se transfundieron plaquetas de donante no fenotipado para el HPA-1a y se inició tratamiento con inmunoglobulinas endovenosas, con recuperación de la trombocitopenia, pero con secuelas neurológicas probablemente irreversibles. El estudio inmunohematológico confirmó el fenotipo materno HPA-1a negativo, el fenotipo neonatal HPA1a positivo y la presencia de aloanticuerpos anti-HPA-1a en el suero materno.La profilaxis y el tratamiento continúan siendo, en la actualidad, motivo de discusión y controversia, así como la posibilidad de realizar un cribado antenatal.Palabras clave. Trombocitopenia aloinmune. Neonatal. Hemorragia intracraneal. ABSTRACTFoetal/neonatal alloimmune thrombocytopenia is the most common cause of severe thrombocytopenia in the newborn. It is an acute disorder which implies that foetal platelets are destroyed during the pregnancy due to a maternal alloimmune IgG antibody. More than 80% of Caucasians are HPA-1a specific. Intracranial haemorrhage, which occurs in 30% of cases, is the most serious complication, with a 10% mortality rate or a 20% rate of irreversible neurological sequels. The high risk of a recurrence of serious bleeding in future pregnances led us to consider prophylaxis or prenatal treatment. An early diagnosis of this process allows an effective therapy to be carried out based on the infusion of compatible phenotype HPA platelets or endovenous immunoglobulins.We present the case of a 27 year old pregnant woman, who in the 35 th week of a second pregnancy was diagnosed using echography with a bilateral foetal hydrocephaly. After caesarean delivery in the 36 th week, the newborn presented haematomas in the left shoulder and gluteus, macrocephalia with tension of th...

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Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?

Cited by 103 publications

References 67 publications

Reconsidering fetal and neonatal alloimmune thrombocytopenia with a focus on screening and prevention

Reconsidering fetal and neonatal alloimmune thrombocytopenia with a focus on screening and prevention

Incidence and Consequences of Neonatal Alloimmune Thrombocytopenia: A Systematic Review

Trombocitopenia fetal/neonatal aloinmune: Revisión a propósito de un caso

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