Giers G, Hoch J, Bald R, Bauer H, Kroll H, Kiefel V, Scharf R E, Hanfland P, Hansmann M, Mueller-Eckhardt C
Institut für Blutgerinnungswesen und Transfusionsmedizin, Universität Düsseldorf.
Beitr Infusionsther Transfusionsmed. 1996;33:160-4.
Fetal alloimmune thrombocytopenia is caused by materno-fetal transfer of platelet antibodies. Since the thrombocytopenic fetus is threatened by intracranial hemorrhage, prenatal observation and, if necessary, treatment is required. However, the benefit of therapeutic options, including intravenous IgG (ivIgG), platelet transfusions or fetal IgG transfusions is still controversial. In this study we have evaluated the effect of intrauterine IgG and intraumbilical platelet transfusions on fetal platelet counts. All patients were multiparous women who were immunized against the Zwa antigen during previous pregnancies and had given birth to at least one severely thrombocytopenic infant. First umbilical blood was sampled at the 20th week of gestation. Fetal treatment of IgG was given, on av erage, over 9 weeks. In all cases, fetal IgG levels rose significantly whereas platelet counts did not increase following fetal IgG treatment. We conclude that fetal IgG infusions have no detectable effect on fetal allo-immune thrombocytopenia. Since platelet counts can be very low as early as 20 weeks of gestation, careful fetal monitoring by umbilical blood sampling is essential. Platelet transfusions in short intervals appear to be the only effective regimen to increase platelet counts in thrombocytopenic fetuses at risk.
胎儿同种免疫性血小板减少症是由母体血小板抗体向胎儿转移引起的。由于血小板减少的胎儿受到颅内出血的威胁，因此需要进行产前观察，必要时还需进行治疗。然而，包括静脉注射免疫球蛋白（ivIgG）、血小板输注或胎儿免疫球蛋白输注在内的治疗方案的益处仍存在争议。在本研究中，我们评估了宫内免疫球蛋白和脐内血小板输注对胎儿血小板计数的影响。所有患者均为经产妇，她们在前次妊娠期间对Zwa抗原产生了免疫反应，并至少分娩过一名严重血小板减少的婴儿。在妊娠第20周采集首次脐血。胎儿免疫球蛋白治疗平均持续9周。在所有病例中，胎儿免疫球蛋白水平显著升高，而胎儿免疫球蛋白治疗后血小板计数并未增加。我们得出结论，胎儿免疫球蛋白输注对胎儿同种免疫性血小板减少症没有可检测到的影响。由于早在妊娠20周时血小板计数就可能非常低，因此通过脐血采样进行仔细的胎儿监测至关重要。短时间间隔的血小板输注似乎是增加有风险的血小板减少胎儿血小板计数的唯一有效方案。
