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OBJECTIVE: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality. STUDY DESIGN: MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018. RESULT: Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 × 109/L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion. CONCLUSION: Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion.

Original publication

DOI

10.1038/s41372-019-0360-7

Type

Journal article

Journal

J Perinatol

Publication Date

10/2019

Volume

39

Pages

1329 - 1339

Keywords

Adrenal Cortex Hormones, Combined Modality Therapy, Fetal Diseases, Humans, Immunoglobulins, Intravenous, Infant, Newborn, Intracranial Hemorrhages, Platelet Count, Platelet Transfusion, Thrombocytopenia, Neonatal Alloimmune