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Fetal thrombocytopenia: a retrospective survey of 5,194 fetal blood
samplings
P Hohlfeld, F Forestier, C Kaplan, JD Tissot and F Daffos
Laboratoire d'hematologie, Universite de Paris-Sud, Faculte de Chatenay
Malabry, Chatenay Malabry, France.
Fetal platelet counts were retrospectively studied in a series of 5,194
consecutive fetal blood samplings (FBS). The mean value was 245 +/- 65 x
10(9)/L, without significant variation between 17 and 41 weeks' gestation.
After exclusion of false thrombocytopenia due to contamination with
amniotic fluid, 247 fetuses had platelet counts less than 150 x 10(9)/L. In
70 cases, thrombocytopenia was due to congenital infectious diseases
(toxoplasmosis, rubella, and cytomegalovirus). It was related to immune
causes in 45 cases: anti-HPA-1a (n = 23), anti- HPA-5b (n = 2) or possible
anti-HLA (n = 2) alloimmunizations, and immune thrombocytopenic purpura (n
= 18). Chromosomal abnormality was the etiology in 43 cases (trisomy 13,
18, and 21, Turner's syndrome, triploidy), and other disorders (multiple
birth defects, intrauterine growth retardation, rhesus disease, and
gestational thrombocytopenia) in 62 cases. No specific cause for the low
platelet count could be established in 27 fetuses (range, 115 to 149 x
10(9)/L). Severe thrombocytopenia (< or = 50 x 10(9)/L) occurred mainly
in immune cases (16%), congenital infectious diseases (7%), and chromosomal
abnormalities (1%). Diagnosis, prognosis, and management of fetal
thrombocytopenia are presented in the different clinical situations. In
this series, FBS was never associated with serious bleeding, and no fetal
exsanguination was observed.
Volume 84,
Issue 6,
pp. 1851-1856,
09/15/1994
Copyright © 1994 by The American Society of Hematology
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