Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 May;3(1):41-4.
doi: 10.1055/s-0032-1331379. Epub 2013 Jan 25.

A case of alloimmune thrombocytopenia, hemorrhagic anemia-induced fetal hydrops, maternal mirror syndrome, and human chorionic gonadotropin-induced thyrotoxicosis

Venu Jain  1 , Gwen Clarke, Laurie Russell, Angela McBrien, Lisa Hornberger, Carmen Young, Sujata Chandra
Affiliations
Case Reports

A case of alloimmune thrombocytopenia, hemorrhagic anemia-induced fetal hydrops, maternal mirror syndrome, and human chorionic gonadotropin-induced thyrotoxicosis

Venu Jain et al. AJP Rep. 2013 May.

Abstract

Fetal/neonatal alloimmune thrombocytopenia (FNAIT) can be a cause of severe fetal thrombocytopenia, with the common presentation being intracranial hemorrhage in the fetus, usually in the third trimester. A very unusual case of fetal anemia progressed to hydrops. This was further complicated by maternal Mirror syndrome and human chorionic gonadotropin-induced thyrotoxicosis. Without knowledge of etiology, and possibly due to associated cardiac dysfunction, fetal transfusion resulted in fetal demise. Subsequent testing revealed FNAIT as the cause of severe hemorrhagic anemia. In cases with fetal anemia without presence of red blood cell antibodies, FNAIT must be ruled out as a cause prior to performing fetal transfusion. Fetal heart may adapt differently to acute hemorrhagic anemia compared with a more subacute hemolytic anemia.

Keywords: FNAIT; HPA 1a; NAIT; antiplatelet antibodies; intraperitoneal transfusion; intrauterine transfusion.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
(Upper panel) Biventricular inflow Dopplers were abnormal with greater flow in early diastole (E) compared with late diastole atrial systole (A), potentially in keeping with abnormal myocardial diastolic function. (Lower panel) Four-chamber view of the heart demonstrating mild cardiomegaly associated with increased biventricular wall thickness or hypertrophy and no chamber dilation. The calculated combined cardiac output was normal for gestational age. LV, left ventricle; RA, right atrium; RV, right ventricle.
Fig. 2
Fig. 2
(Upper panel) Peritoneal aspiration and transfusion. The white arrow delineates the needle inserted into fetal abdomen for drainage of ascites and intraperitoneal transfusion. (Lower panel) Posttransfusion middle cerebral artery Dopplers. The peak systolic velocity is within normal range for this gestation; however, very high diastolic flow is seen. A, hemorrhagic ascites; L, fetal liver; P, hydropic placenta.
Fig. 3
Fig. 3
The stillborn fetus shows hydrops and extensive petechial hemorrhages on skin.
See this image and copyright information in PMC

References

    1. Nordvall M, Dziegiel M, Hegaard H K. et al.Red blood cell antibodies in pregnancy and their clinical consequences: synergistic effects of multiple specificities. Transfusion. 2009;49:2070–2075. - PubMed
    1. Forouzan I. Hydrops fetalis: recent advances. Obstet Gynecol Surv. 1997;52:130–138. - PubMed
    1. Illanes S, Soothill P. Management of red cell alloimmunisation in pregnancy: the non-invasive monitoring of the disease. Prenat Diagn. 2010;30:668–673. - PubMed
    1. Mari G, Deter R L, Carpenter R L. et al.Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses . Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. N Engl J Med. 2000;342:9–14. - PubMed
    1. Weiner C P, Williamson R A, Wenstrom K D. et al.Management of fetal hemolytic disease by cordocentesis. II. Outcome of treatment. Am J Obstet Gynecol. 1991;165(5 Pt 1):1302–1307. - PubMed

Publication types