MATERNAL INTRAVENOUS IMMUNOGLOBULIN TREATMENT DOES NOT PREVENT INTRACRANIAL HEMORRHAGE IN FETAL ALLOIMMUNE THROMBOCYTOPENIA

In fetal alloimmune thrombocytopenia (FAIT) the fetus is threatened by intracranial haemorrhage (ICH); therefore early diagnostic and therap eutic intervention is required. We followed the clinical course of a 3 0-year-old woman during her fifth pregnancy after she had given birth to a child with alloimmune thrombocytopenia due to anti-Zw(2). The fet us was monitored by 13 fetal blood samplings (FBS) always followed by transfusion of either maternal or compatible donor platelets. Intraven ous immunoglobulin (ivIg) treatment of the mother was begun at 20 week s of gestation when the fetal platelet count was 36 x 10(9)/l. The fet al platelets were typed Zw(2) positive by DNA analysis. Despite 11 wee ks of maternal ivIg treatment fetal platelet counts progressively decl ined to 6x10(9)/l and ICH occurred. Subsequently, the fetus was succes sfully managed by intrauterine platelet transfusions at shorter interv als (3-5 days) and elective Cesarean section was carried out at 35 wee ks of gestation. We conclude that maternal ivIg treatment does not pre vent ICH in FAIT. The treatment of choice for severely affected cases is serial FBS combined with transfusion of compatible platelets.