Experiences with fetomaternal alloimmune thrombocytopenia at a Swedish hospital over a 10-year period

Background. This is a descriptive study of the management and outcome of 18 cases of fetomaternal alloimmune thrombocytopenia (FMAIT) treated from 1991 to 2001. Material and methods. Management of the disease changed over the years from cordocentesis in the 20-24th week of gestation, platelet transfusions and immunoglobulin to a less invasive management consisting of only blind administration of immunoglobulin and predelivery cordocentesis. Results. Three of the fetuses were treated with intrauterine platelet transfusions. Two of these were delivered by emergency cesarean section due to failed transfusions and the third fetus died as a result of the procedure. Nine mothers were treated with immunoglobulin intravenously. Four of these delivered thrombocytopenic children. Three women did not want to undergo any treatment, and all newborns had low platelet counts. Two fetuses died, one in conjunction with a platelet transfusion and the other in utero before treatment was commenced. All the other children did well despite the fact that some of them were severely thrombocytopenic at birth. Conclusions. Due to the limited number of patients, the present material does not allow any far reaching conclusions. Our experience is that a non-invasive management can be practiced in cases of FMAIT. The value of performing cordocentesis and platelet transfusions in the second trimester is doubtful in view of the risk for the fetus and the limited amount of information it provides for management of the individual case.