Pregnant Women at Low Risk of Having a Child with Fetal and Neonatal Alloimmune Thrombocytopenia Do Not Require Treatment with Intravenous Immunoglobulin
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https://hdl.handle.net/10037/31776Date
2023-08-24Type
Journal articleTidsskriftartikkel
Peer reviewed
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare condition in which
maternal alloantibodies to fetal platelets cause fetal thrombocytopenia that may lead to intracranial
hemorrhage (ICH). Off-label intravenous immunoglobulin (IVIg) has for 30 years been the standard of
care for pregnant women who previously have had a child with FNAIT. The efficacy of this treatment
has never been tested in a placebo-controlled clinical trial. Although IVIg treatment may improve
the neonatal outcome in women who previously have had a child with FNAIT-associated ICH, the
question is whether IVIg is necessary for all immunized pregnant women at risk of having a child
with FNAIT. The results from some recent publications suggest that antenatal IVIg treatment is not
necessary for women who are (1) HPA-1a-immunized and HLA-DRB3*01:01-negative, (2) HPA-1aimmunized with a previous child with FNAIT but without ICH or (3) HPA-5b-immunized. If IVIg is
not used for these categories of pregnant women, the amount of IVIg used in pregnant women with
platelet antibodies would be reduced to less than 1/4 of today’s use. This is important because IVIg is
a scarce resource, and the collection of plasma for the treatment of one pregnant woman is not only
extremely expensive but also requires tremendous donor efforts.
Publisher
MDPICitation
Kjeldsen-Kragh, Bein, Tiller. Pregnant Women at Low Risk of Having a Child with Fetal and Neonatal Alloimmune Thrombocytopenia Do Not Require Treatment with Intravenous Immunoglobulin. Journal of Clinical Medicine. 2023;12(17):1-10Metadata
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