Saade G R, Moise K J, Copel J A, Belfort M A, Carpenter R J
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Obstet Gynecol. 1993 Dec;82(6):987-91.
To determine whether fetal anemia secondary to maternal red-cell alloimmunization is associated with thrombocytopenia.
The records of 78 patients undergoing intrauterine transfusion for red-cell alloimmunization were reviewed. Pre-transfusion fetal platelet counts were compared between hydropic and nonhydropic fetuses. A regression analysis was performed between the fetal platelet counts and the fetal bilirubin levels, hematocrits, and reticulocyte counts taken at the initial transfusion. The hematocrits, reticulocyte counts, and bilirubin levels were adjusted for gestational age by calculating the number of standard deviations (SDs) from the mean for that age or the multiples of the mean (MOM). Student t test, Pearson coefficient, and contingency table randomization test were used to analyze the data. P < .05 was considered significant.
Thirty-seven fetuses were hydropic and 41 were nonhydropic. Hydropic fetuses had a significantly lower platelet count than nonhydropic fetuses (197.5 +/- 86.4 versus 252.6 +/- 73.7 x 10(3)/microL; P < .01). Platelet counts correlated negatively with the reticulocyte count MOM (r = -0.652; P < .01) and the hematocrit SDs below the mean (r = -0.659; P < .01), but did not correlate with the bilirubin MOM (r = -0.183; P = .2).
Hydropic and severely anemic fetuses are at increased risk for thrombocytopenia. We suggest that increased erythropoiesis diverts the hematopoietic stem cell away from thrombopoiesis.
确定母体红细胞同种免疫继发的胎儿贫血是否与血小板减少有关。
回顾了78例因红细胞同种免疫接受宫内输血患者的记录。比较了水肿胎儿和非水肿胎儿输血前的胎儿血小板计数。对首次输血时的胎儿血小板计数与胎儿胆红素水平、血细胞比容和网织红细胞计数进行了回归分析。通过计算相对于该年龄平均值的标准差（SD）数量或平均值倍数（MOM），对血细胞比容、网织红细胞计数和胆红素水平进行胎龄校正。采用学生t检验、Pearson系数和列联表随机化检验分析数据。P < 0.05被认为具有统计学意义。
37例胎儿为水肿型，41例为非水肿型。水肿胎儿的血小板计数明显低于非水肿胎儿（197.5±86.4对252.6±73.7×10³/μL；P < 0.01）。血小板计数与网织红细胞计数MOM呈负相关（r = -0.652；P < 0.01），与低于平均值的血细胞比容SD呈负相关（r = -0.659；P < 0.01），但与胆红素MOM无相关性（r = -0.183；P = 0.2）。
水肿和严重贫血的胎儿血小板减少风险增加。我们认为，红细胞生成增加使造血干细胞从血小板生成中转移。
