van den Akker Eline S A, de Haan Timo R, Lopriore Enrico, Brand Anneke, Kanhai Humphrey H H, Oepkes Dick
Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
Am J Obstet Gynecol. 2008 Oct;199(4):387.e1-4. doi: 10.1016/j.ajog.2008.07.001.
The objective of the study was to evaluate the incidence of fetal thrombocytopenia and association with hydrops in Rhesus D alloimmunization.
The study was a retrospective chart review of 914 intrauterine transfusions in 314 pregnancies performed between 1988 and 2005 in a single institution. The incidence of thrombocytopenia and severity of hydrops at cordocentesis were assessed and correlated with perinatal mortality.
Thrombocytopenia (less than 150 x 10(9)/L) was found in 241 of 914 (26%) and severe thrombocytopenia (less than 50 x 10(9)/L) in 25 of 914 (3%) cordocentesis. Twenty-three percent of severely hydropic fetuses had severe thrombocytopenia, compared with 3% and 1% of mildly hydropic and nonhydropic fetuses, respectively. Thrombocytopenia was an independent risk factor for perinatal mortality. Mortality in fetuses that were severely thrombocytopenic and severely hydropic was 67%.
Thrombocytopenia is common in hydropic anemic fetuses. Severe thrombocytopenia is associated with a poor prognosis, irrespective of the presence of hydrops. The option of platelet transfusion in severely hydropic anemic fetuses needs further study.
本研究的目的是评估恒河猴D同种免疫中胎儿血小板减少症的发生率及其与水肿的相关性。
该研究是对1988年至2005年在单一机构进行的314例妊娠中的914次宫内输血进行回顾性图表审查。评估了脐带穿刺时血小板减少症的发生率和水肿的严重程度，并与围产期死亡率相关联。
在914次脐带穿刺中，有241例（26%）出现血小板减少症（低于150×10⁹/L），25例（3%）出现严重血小板减少症（低于50×10⁹/L）。重度水肿胎儿中有23%出现严重血小板减少症，而轻度水肿和非水肿胎儿的这一比例分别为3%和1%。血小板减少症是围产期死亡的独立危险因素。严重血小板减少且重度水肿的胎儿死亡率为67%。
血小板减少症在水肿性贫血胎儿中很常见。严重血小板减少症与预后不良相关，无论是否存在水肿。对于重度水肿性贫血胎儿进行血小板输血的选择需要进一步研究。
