The Sonographic Detection of Intracranial Hemorrhage Due to Alloimmune Thrombocytopenia

Abstract

Alloimmune thrombocytopenia is a rare condition in which antibodies from the mother's circulation cross the placenta and destroy the platelets in the fetus. Approximately 14% of affected fetuses or neonates develop intracranial hemorrhage, leading to death or long-term central nervous system disabilities. After treating two such cases, 26 previously reported cases of alloimmune thrombocytopenia with intracranial hemorrhage were examined to discover if these hemorrhages exhibit a typical sonographic appearance, course, and time of hemorrhage. When intracranial hemorrhage occurs in cases of alloimmune thrombocytopenia, it has a typical appearance in 76% of cases: a large hematoma in the center of the cerebral hemisphere. There is no difference between genders in the occurrence of alloimmune thrombocytopenia unless hemorrhage occurs: 72% of neonates with alloimmune thrombocytopenia and intracranial hemorrhage are male. Intracranial hemorrhage occurs before labor and delivery in 76% of cases. Sonographers cannot depend on a history of the condition in previous pregnancies as an indication of alloimmune thrombocytopenia: only 35% of neonates with alloimmune thrombocytopenia and hemorrhage have previously affected siblings.