对于有颅内出血高风险的同种免疫性胎儿及新生儿血小板减少症，不进行初始及后续的胎儿脐血穿刺术时静脉注射免疫球蛋白的情况。
Intravenous immunoglobulins without initial and follow-up cordocentesis in alloimmune fetal and neonatal thrombocytopenia at high risk for intracranial hemorrhage.
作者信息
Kanhai Humphrey H H, van den Akker Eline S A, Walther Frans J, Brand Anneke
机构信息
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Fetal Diagn Ther. 2006;21(1):55-60. doi: 10.1159/000089048.
OBJECTIVE
To report on a less invasive treatment strategy in alloimmune fetal and neonatal thrombocytopenia (FNAIT) at high risk for either in utero or neonatal intracranial hemorrhage (ICH).
METHODS
In 7 pregnancies, with a history of ICH in the older sibling, weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg) without initial cordocentesis was started at a median gestational age of 16 weeks.
RESULTS
In 4 pregnancies cordocentesis was avoided. One predelivery cordocentesis with platelet transfusion was performed in 3 further cases. Although none of the cases had a platelet count of >50 x 10(9)/l at cordocentesis, predelivery or birth, no ICHs were observed. The neonatal periods of the infants were uncomplicated.
CONCLUSION
IVIG treatment alone might be considered in patients with both severe platelet alloimmunization and an increased risk for morbidity and mortality at cordocentesis.
目的
报告一种针对有宫内或新生儿颅内出血（ICH）高风险的同种免疫性胎儿及新生儿血小板减少症（FNAIT）的侵入性较小的治疗策略。
方法
7例妊娠中，年长同胞有颅内出血病史，于孕16周中位数时开始每周给母亲静脉注射免疫球蛋白（IVIG）（1g/kg），且不进行初始脐带穿刺术。
结果
4例妊娠避免了脐带穿刺术。另外3例进行了1次产前脐带穿刺术并输注血小板。尽管在脐带穿刺术、产前或出生时，无一例血小板计数>50×10⁹/L，但未观察到颅内出血。婴儿的新生儿期无并发症。
结论
对于严重血小板同种免疫且脐带穿刺术有发病和死亡风险增加的患者，可考虑单独使用IVIG治疗。
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