Fetal and Neonatal Cytopenias: What Have We Learned?

ABSTRACT

Rh disease has largely disappeared as a result of prophylaxis with anti-D. However, the cases that remain are more complicated with a combination of novel challenges with regard to in utero management with transfusion and its effects on the course of the neonate, both early and late. Thrombocytopenia in the neonate can be severe and recurrent if it is a result of alloimmunization. Newer techniques in the laboratory have improved the security of diagnosis. Antenatal management of affected fetuses with treatment administered to the mother is now well established although studies are ongoing. Neutropenia is a complication of pre-eclampsia; the mechanism is still not well understood.

KEYWORDS

Thrombocytopenia - hemolytic anemia - neutropenia - immunohematology

REFERENCES

• 1 Chitkara U, Bussel J B, Alvarez M, Lynch L, Meisel R L, Berkowitz R L. High-dose intravenous gamma globulin: does it have a role in the treatment of severe erythroblastosis fetalis?.  Obstet Gynecol . 1990;  76 703-708
• 2 Inglis S R, Lysikiewicz A, Sonnenblick A L, Bussel J, Chervenak F A. Advantages of larger volume, less frequent intrauterine red blood cell transfusions for maternal red cell alloimmunization.  Am J Perinatol . 1996;  13 27-33
• 3 Scaradavou A, Inglis S, Peterson P, Dunne J, Chervenak F, Bussel J. Suppression of erythropoiesis by intrauterine transfusions in hemolytic disease of the newborn: use of erythropoietin to treat the late anemia.  J Pediatr . 1993;  123 279-284
• 4 Samuels P, Bussel J B, Braitman L. et al . Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura.  N Engl J Med . 1990;  323 229-235
• 5 Lescale K B, Eddleman K A, Cines B. et al . Antiplatelet antibody testing in the thrombocytopenic pregnant woman.  Am J Obstet Gynecol . 1996;  174 1014-1018
• 6 Bussel J B, Berkowitz R L, McFarland J G, Lynch L, Chitkara U. Antenatal treatment of neonatal alloimmune thrombocytopenia.  N Engl J Med . 1988;  319 1374-1378
• 7 Bussel J B, Zabusky M R, Berkowitz R L, McFarland J G. Fetal alloimmune thrombocytopenia.  N Engl J Med . 1997;  337 22-26
• 8 Bussel J B, Berkowitz R L, Lynch L. et al . Antenatal management of alloimmune thrombocytopenia with intravenous gamma globulin: a randomized trial of the addition of low-dose steroids to IVIG in fifty-five maternal-fetal pairs.  Am J Obstet Gynecol . 1996;  174 1414-1423
• 9 Gaddipati S, Berkowitz R L, Lembet A A, Lapinski R, McFarland J G, Bussel J B. Initial fetal platelet counts predict the response to intravenous gamma globulin therapy in fetuses affected by PLA1 incompatibility.  Am J Obstet Gynecol . 2001;  185 976-980