St. Michael's Hospital and The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Canada.
J Perinatol. 2019 Oct;39(10):1329-1339. doi: 10.1038/s41372-019-0360-7. Epub 2019 Apr 10.
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.
MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018.
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 × 10/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.
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.
胎儿和新生儿同种免疫性血小板减少症（FNAIT）与危及生命的出血有关。本系统评价检查了 FNAIT 出生后管理中 HPA 选择或非选择血小板输注和/或 IVIg 对血小板计数增加、出血和死亡率的影响。
对 MEDLINE、EMBASE 和 Cochrane 进行了检索，检索时间截至 2018 年 5 月 11 日。
754 例新生儿中，382 例接受了血小板输注（51%）。HPA 选择的血小板比 HPA 非选择的血小板引起更高的血小板计数增加和更长的反应时间。然而，非选择的血小板通常足以将血小板计数增加到 30×10/L 以上，在这个水平以上，很少发生颅内出血或其他危及生命的出血。血小板输注中添加 IVIg 并不能改善血小板计数增加。
总体而言，HPA 选择的血小板输注比 HPA 非选择的血小板更有效，但非选择的血小板通常足以达到临床目标。现有研究并未明确表明血小板输注中添加 IVIg 有获益。
