20 research outputs found
Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage
We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia
A modified PF4-dependent, CD62p expression assay selectively detects serotonin-releasing antibodies in patients suspected of HIT
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Alloimmune thrombocytopenia: Fetal and neonatal losses related to cordocentesis
OBJECTIVE: This report describes the increased risks of cordocentesis in fetuses affected with alloimmune thrombocytopenia.
STUDY DESIGN: as part of a multicenter treatment study clinical and laboratory data from five pregnancies with alloimmune thrombocytopenia in which there was a fetal or neonatal loss associated with cordocentesis were reviewed. The fetal or neonatal deaths were all thought to be a result of exsanguination. These fetuses were compared with a group of 44 affected fetuses who underwent the same procedure but who survived. The data were analyzed by the Wilcoxon rank-sum test and the two-tailed Fisher's exact test. A
p value <0.05 was considered significant.
RESULTS: The mean platelet count at cordocentesis was significantly lower in the cases than in the controls (5.8 vs 32.8 × 10
8/L,
p = 0.005). The incidence of antenatal infracranial hemorrhage in the untreated sibling of the prior affected pregnancy was significantly greater in the cases than in the controls (two of five vs one of 42,
p = 0.02).
CONCLUSION: Fetuses affected wth alloimmune thrombocytopenia are at increased risk for fatal exsanguination associated with cordocentesis
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Antenatal management of alloimmune thrombocytopenia with intravenous γ-globulin: A randomized trial of the addition of low-dose steroid to intravenous γ-globulin
OBJECTIVES: Our purposes were to investigate maternal infusions of intravenous
γ-globulin used to increase the platelet count in thrombocytopenic fetuses with alloimmune thrombocytopenia, to prevent intracranial hemorrhage, and to determine whether 1.5 mg dexamethasone and 60 mg prednisone per day add to the effect of intravenous
γ-globulin.
STUDY DESIGN: Fifty-four women with alloimmune thrombocytopenia and thrombocytopenic fetuses were randomized to intravenous
γ-globulin 1 gm/kg per week with or without dexamethasone. Nonresponders after 4 to 6 weeks received continued intravenous
γ-globulin plus 60 mg of prednisone per day (“salvage”).
RESULTS: Dexamethasone did not add to the effect of intravenous
γ-globulin. Overall, there was a mean platelet increase from the first to the second fetal blood sampling of 36,000/μl (
n = 47) and from the first fetal blood sampling to birth of 69,000/μl (
n = 54). A total of 62% to 85% of fetuses responded. There were no intracranial hemorrhages. “Salvage” increased the platelet count in 5 of 10 nonresponders to intravenous
γ-globulin.
CONCLUSION: Intravenous
γ-globulin treatment is appropriate for thrombocytopenic fetuses with alloimmune thrombocytopenia before use of weekly in utero platelet transfusions, even in severe thrombocytopenia. (AM J OBSTET GYNECOL 1996;174:1414-23.