Immune thrombocytopenia in the foetus and the newborn: diagnosis and therapy
Immune thrombocytopenia in the foetus and the newborn: diagnosis and therapy
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DOI：
10.1016/s1246-7820(01)00114-8
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发表时间：
2001-06-01
影响因子：
1.7
通讯作者：
Kaplan, C
中科院分区：
文献类型：
--
作者：
Kaplan, C
血小板减少症是重症监护室的常见病症。然而，新生儿血小板减少症在所有新生儿中的发生率(<；150(.)10(9)/L)估计为1-4%。母体抗血小板免疫球蛋白通过胎盘途径引起的胎儿/新生儿免疫性血小板减少症是健康新生儿的一过性被动疾病。严重血小板减少的主要风险是颅内出血(ICH)，导致死亡或神经功能障碍。对受影响的婴儿进行管理的主要目的是预防严重的血小板减少症的有害后果。孕妇自身免疫性血小板减少性紫癜(AITP)可在胎儿或新生儿中引起中度或严重的血小板减少，无论母亲的疾病状态如何。胎儿血小板减少症最早可在妊娠20周时发生。据估计，脑出血的发生率为1-3%。胎儿的血小板减少是无法预防的。出生后，在生命的最初几天，血小板减少症通常会恶化。出生后的处理通常是静脉注射免疫球蛋白。新生儿同种免疫性血小板减少症被认为是新生儿溶血性疾病的血小板反应。严重的中枢神经系统出血和死亡(10%的病例)或神经后遗症(20%的病例)可能会发生。据估计，新生儿同种免疫性血小板减少症的发生率为每800-1000名活产儿中有1名。出生后，母体输注血小板是首选治疗方法。由于胎儿血小板减少症在随后的妊娠中复发的风险很高，已经提出了产前管理的方案，包括静脉注射免疫球蛋白和/或皮质类固醇的母体治疗，或宫内输血。2001年版科学与医学爱思唯尔爱思唯尔公司。
Thrombocytopenia is a common condition in intensive care units. However the frequency of neonatal thrombocytopenia in all newborns (< 150(.)10(9)/L) has been estimated at 1-4%. Foetal/neonatal immune thrombocytopenia due to the transplacental passage of maternal antiplatelet IgG is a transient passive disease in an otherwise healthy newborn. The major risk of severe thrombocytopenia is intracranial haemorrhage (ICH) leading to death or neurological impairment. The principal aim in the management of the affected infants is to prevent the deleterious consequences of severe thrombocytopenia. Autoimmune thrombocytopenic purpura (AITP) in pregnant women can induce moderate or severe thrombocytopenia in the foetus or the newborn whatever the mother's disease status. Foetal thrombocytopenia can occur as early as 20 weeks of gestation. The frequency of ICH has been estimated to be 1-3% of cases. Foetal thrombocytopenia cannot be prevented. After birth, thrombocytopenia usually worsens during the first days of life. Postnatal management is usually ly of intravenous immunoglobulins. Neonatal alloimmune thrombocytopenia is considered to be the platelet counterpart of haemolytic disease of the newborn. Severe bleeding in the central nervous system and death (10% of cases) or neurological sequelae (20% of cases) may occur. The incidence of neonatal alloimmune thrombocytopenia has been estimated at 1 per 800-1000 live births. After birth, maternal platelet transfusion is the treatment of choice. Due to the high risk of recurrence of foetal thrombocytopenia in subsequent pregnancies, protocols for antenatal management including maternal therapy with intravenous immunoglobulins and/or corticosteroids, or in utero transfusion have been proposed. 2001 Editions scientifiques et medicales Elsevier SAS.