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Fetomaternal alloimmune thrombocytopenia: a literature review and statistical analysis
Author(s) -
Spencer Jillian A,
Burrows Robert F
Publication year - 2001
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.2001.tb01293.x
Subject(s) - medicine , relative risk , confidence interval , pregnancy , platelet transfusion , neonatal alloimmune thrombocytopenia , pediatrics , platelet , obstetrics , fetus , genetics , biology
SUMMARY Exploring prognostic factors that determine outcomes in fetomaternal alloimmune thrombocytopenia (FMAIT), a search of Medline was performed covering the years 1966 to April 1998.376 articles were collected and reviewed; 140 articles contained the case histories of 297 mothers and 433 pregnancies that fulfilled entry criteria. More than 30 data variables were sought from these cases. The data were analysed using SPSS and Arcus Quickstat Biomedical. Nineteen different antigen incompatibilities were documented, the majority being human platelet antigen (HPA)‐la (77.3%), HPA‐3a (3.5%) and HPA‐5b (3.5%). The relative risk reduction (RRR) in mortality with any intervention was 57% (0.19‐0.77) p = 0.009. Treatment of HPA‐la (P1 A1 ) pregnancies with intravenous immunoglobulin (IVIG) increased the likelihood of a neurologically normal outcome, relative risk (RR) 1.68, confidence interval (1.3‐2.2) p = 0.0003. Treatment of HPA‐la (P1 A1 ) pregnancies with only antenatal complementary platelet transfusions increased the likelihood of a neurologically normal outcome, RR 1.63 (1.1–2.1) p = 0.01. Despite reviews of more than 400 cases of FMAIT, few prognostic variables are identifiable. Although IVIG appears to reduce the risk of intracranial haemorrhage (ICH), the dosage and timing of IVIG treatment was varied. This study highlights the need for standardised and directed research.