Antenatal interventions for fetomaternal alloimmune thrombocytopenia

Source:
NICE Quality and Productivity Case Studies
Publisher:
Queen's University Belfast
Publication date:
25 October 2011

Abstract

NICE summary of review conclusions

Evidence shows that the harms of treating fetomaternal alloimmune thrombocytopenia with dexamethasone alone, or in combination with intravenous immunoglobulin may outweigh the benefits.

Reducing or stopping antenatal administration of dexamethasone in fetomaternal alloimmune thrombocytopenia is likely to improve the quality of patient care and result in productivity savings by avoiding an unproven intervention with an unknown safety profile.

The Implications for practice section of the Cochrane review stated:

There is no evidence that, when added to intravenous immunoglobulin, antenatally administered dexamethasone improves platelet count at birth. Since dexamethasone has been reported as causing fetal oligohydramnios and this trial also reported significant effects on the mother, dexamethasone is not recommended for the antenatal treatment of fetomaternal alloimmune thrombocytopenia, especially since alternative corticosteroids are available.

Intravenous immunoglobulin or prednisone can be used as first line treatment for standard-risk fetomaternal alloimmune thrombocytopenia, where there was no peripartum haemorrhage in an affected sibling and the pre-treatment fetal platelet count (if performed) is over 20 x 10*9/l. However, the optimal dose of both prednisone and IVIG has not been established.

Intravenous immunoglobulin in combination with prednisone is more effective in raising the fetal platelet count than IVIG alone in high-risk pregnancies, where the pre-treatment fetal platelet count is less than 20 x10*9/l or the affected sibling sustained a peripartum intracranial haemorrhage. The optimal timing of administration and the dose of prednisone and intravenous immunoglobulin is unclear.