Porcelijn L, Kanhai H H
CLB, Sanguin Blood Supply Foundation, Amsterdam, The Netherlands.
Curr Opin Obstet Gynecol. 1998 Apr;10(2):117-22. doi: 10.1097/00001703-199804000-00007.
In idiopathic thrombocytopenic purpura, the low risk of fetal bleeding in the perinatal period does not justify routine cordocentesis. Platelet counts of second newborns correlates well with that of their siblings. In neonatal alloimmune thrombocytopenia, the initial platelet count at cordocentesis in the second trimester is low in the next pregnancy. Weekly high doses of intravenous gammaglobulin to the mother results in a rise of fetal platelet count in approximately 70% of cases and may protect the fetus against intracranial haemorrhage in cases without significant platelet rise. With the exception of cases with a prior infant with spontaneous fetal intracranial haemorrhage, the use of diagnostic fetal blood sampling to confirm neonatal alloimmune thrombocytopenia is controversial.
在特发性血小板减少性紫癜中,围产期胎儿出血风险较低,因此常规进行脐带穿刺术并无必要。第二个新生儿的血小板计数与其兄弟姐妹的血小板计数密切相关。在新生儿同种免疫性血小板减少症中,孕中期进行脐带穿刺时最初的血小板计数在下一次妊娠时较低。母亲每周静脉注射大剂量丙种球蛋白,约70%的病例中胎儿血小板计数会升高,对于血小板计数无显著升高的病例,这可能会保护胎儿免受颅内出血。除了之前有婴儿发生自发性胎儿颅内出血的病例外,使用诊断性胎儿血液采样来确诊新生儿同种免疫性血小板减少症存在争议。