Postnatal intervention for the treatment of FNAIT: a systematic review.
Baker JM., Shehata N., Bussel J., Murphy MF., Greinacher A., Bakchoul T., Massey E., Lieberman L., Landry D., Tanael S., Arnold DM., Baidya S., Bertrand G., Kjaer M., Kaplan C., Kjeldsen-Kragh J., Oepkes D., Savoia H., Ryan G., Hume H., International Collaboration for Transfusion Medicine Guidelines (ICTMG) None.
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.