Hematologie
Contributions
Type: Publication Only
Background
FMAIT can lead to serious complications such as intracranial hemorrhage. The current consensus is to initiate first line prophylactic treatment with IVIg and corticotherapy. We describe 2 cases of successful prophylactic treatment of FMAIT with enriched IVIg and corticotherapy. Infusion of enriched IVIg is interesting to the quality of life in outpatient setting. Time of infusion is faster than standard IVIg.
Aims
Ms VH born in 1982 gave birth normally to a 2.130 g girl in 2005. In 2008 a second pregnancy was medically terminated during week 30 because of fetal hydrocephalus. The post expulsion evaluation identified FMAIT caused by incompatibility of parental HPA1 and HPA3 platelet groups and anti-platelet alloantibodies against HPA1a/a and HPA3a/a. In 2009 this woman begin a third pregnancy and was treated prophylatically with lyophilized IVIg (Tegeline 5%, 1 g/kg bodyweight) from the 16th week combined with Prednisolone (60 mg/day) from week 30. A healthy 2.070 g girl was delivered by caesarean section during week 33. This woman initiated 2 new pregnancies in 2011 and 2013 treated with prophylactic infusion of enriched IVIg (Privigen 10%, 1 g/kg bodyweight) from week 19 combined with Prednisolone (60 mg/day) started during week 32. In 2011 she gave birth by caesarean section at 37 weeks to a 3.370 g girl. In 2013 a scheduled caesarean section was performed on week 37 and a 2.460 g girl was born.
Methods
Ms SA born in 1973 is mother of 1 child with no reported clinical issues. During her second pregnancy in 2014, thrombocytopenia was observed at the 5th month with a maternal platelet count of 35 000/mm3. FMAIT is diagnosed with parental HPA5 incompatibility and anti-platelet alloantibodies against HPAa/b. Prophylactic treatment with enriched IVIg (Privigen 10 %, 1 g/kg bodyweight) was started during week 18. Platelet count of 190 000/mm3 was observed 2 weeks after. Prednisolone (40 mg/day) was started during week 32. A caesarean section was performed on week 38 with birth of a 2. 800 g boy.
Results
Owing to the morbidity of FMAIT IVIg prophylactic treatment with corticotherapy is nowadays considered a standard approach. IVIg are generally intiated during weeks 16 – 18 of pregnancy and continued until planned caesarean section 2 – 4 weeks before the due date. The current consensus on the IVIg dose is 1 g/kg bodyweight per week. Corticotherapy is regularly combined with IVIg from week 30. Interest of enriched IVIg concerns particularly the quality of life of these patients.
Summary
To our knowledge this is the first report of FMAIT treatment with enriched IVIg preparation which was well tolerated and effective consistent with the profile of standard IVIg. Prophylactic treatment of FMAIT depends on identification of risk factors from previous pregnancies with diagnosis by laboratories experienced in biological platelet testing. Management must involve close multidisciplinary collaboration between obstetrics team and hematologists experienced in IVIg use. Surveillance mainly involves fetal echographic monitoring and maternal biological parameters follow-up. Based on our experience use of enriched IVIg in women at high risk of FMAIT is efficient and safe.
Keyword(s): Platelet, Pregnancy
Session topic: Publication Only
Type: Publication Only
Background
FMAIT can lead to serious complications such as intracranial hemorrhage. The current consensus is to initiate first line prophylactic treatment with IVIg and corticotherapy. We describe 2 cases of successful prophylactic treatment of FMAIT with enriched IVIg and corticotherapy. Infusion of enriched IVIg is interesting to the quality of life in outpatient setting. Time of infusion is faster than standard IVIg.
Aims
Ms VH born in 1982 gave birth normally to a 2.130 g girl in 2005. In 2008 a second pregnancy was medically terminated during week 30 because of fetal hydrocephalus. The post expulsion evaluation identified FMAIT caused by incompatibility of parental HPA1 and HPA3 platelet groups and anti-platelet alloantibodies against HPA1a/a and HPA3a/a. In 2009 this woman begin a third pregnancy and was treated prophylatically with lyophilized IVIg (Tegeline 5%, 1 g/kg bodyweight) from the 16th week combined with Prednisolone (60 mg/day) from week 30. A healthy 2.070 g girl was delivered by caesarean section during week 33. This woman initiated 2 new pregnancies in 2011 and 2013 treated with prophylactic infusion of enriched IVIg (Privigen 10%, 1 g/kg bodyweight) from week 19 combined with Prednisolone (60 mg/day) started during week 32. In 2011 she gave birth by caesarean section at 37 weeks to a 3.370 g girl. In 2013 a scheduled caesarean section was performed on week 37 and a 2.460 g girl was born.
Methods
Ms SA born in 1973 is mother of 1 child with no reported clinical issues. During her second pregnancy in 2014, thrombocytopenia was observed at the 5th month with a maternal platelet count of 35 000/mm3. FMAIT is diagnosed with parental HPA5 incompatibility and anti-platelet alloantibodies against HPAa/b. Prophylactic treatment with enriched IVIg (Privigen 10 %, 1 g/kg bodyweight) was started during week 18. Platelet count of 190 000/mm3 was observed 2 weeks after. Prednisolone (40 mg/day) was started during week 32. A caesarean section was performed on week 38 with birth of a 2. 800 g boy.
Results
Owing to the morbidity of FMAIT IVIg prophylactic treatment with corticotherapy is nowadays considered a standard approach. IVIg are generally intiated during weeks 16 – 18 of pregnancy and continued until planned caesarean section 2 – 4 weeks before the due date. The current consensus on the IVIg dose is 1 g/kg bodyweight per week. Corticotherapy is regularly combined with IVIg from week 30. Interest of enriched IVIg concerns particularly the quality of life of these patients.
Summary
To our knowledge this is the first report of FMAIT treatment with enriched IVIg preparation which was well tolerated and effective consistent with the profile of standard IVIg. Prophylactic treatment of FMAIT depends on identification of risk factors from previous pregnancies with diagnosis by laboratories experienced in biological platelet testing. Management must involve close multidisciplinary collaboration between obstetrics team and hematologists experienced in IVIg use. Surveillance mainly involves fetal echographic monitoring and maternal biological parameters follow-up. Based on our experience use of enriched IVIg in women at high risk of FMAIT is efficient and safe.
Keyword(s): Platelet, Pregnancy
Session topic: Publication Only