迎接挑战:胎儿和新生儿同种免疫性血小板减少症的国际德尔菲共识研究。

IF 15.4 1区 医学 Q1 HEMATOLOGY
Romy Pothof, Elske M van den Akker-van Marle, Thijs W de Vos, Heidi Tiller, James B Bussel, Maria Therese Ahlén, Brian R Curtis, Enrico Lopriore, E J T Joanne Verweij, Masja de Haas
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引用次数: 0

摘要

胎儿和新生儿同种免疫性血小板减少症(FNAIT)是一种胎儿有严重血小板减少危险的疾病,可能导致颅内出血,原因是母体形成对抗人血小板抗原(HPAs)的同种抗体。目前,没有FNAIT筛选方案存在。有FNAIT风险的妊娠是在以前生过FNAIT儿童的个体中确定的。这种情况的处理因国家而异。来自欧洲、美国、加拿大和澳大利亚的FNAIT修正德尔菲专家组成员,来自产科、新生儿、儿科、实验室和输血医学、血液学、卫生技术评估和人口筛查相关管理的专家小组被邀请参加本研究。德尔菲研究包括三轮在线问卷,由荷兰FNAIT专家中心的专业人员与合著者合作制定,并于2023年4月在荷兰莱顿举行了一次现场会议。莱顿现场会议的经费来自荷兰研究理事会。最后一份调查表有35项关于目前管理和可能的产前FNAIT筛查方案的说明。答案选项是:同意,不同意,既不同意也不同意,以及不充分的知识。共识阈值设定为80%。经过三轮问卷调查,35项陈述中有25项(71%)达成共识。专家们一致同意使用抗hpa -1a抗体水平来识别高风险的FNAIT妊娠,尽管没有明确的临界值。专家组就设计一种仅基于抗hpa -1a抗体水平测量的具有成本效益的筛选方案达成共识。在FNAIT妊娠中,在静脉注射免疫球蛋白中添加皮质类固醇和分娩方式两方面观察到国际差异。德尔菲研究促进了国际知识的分享,从而澄清了与感知到的护理标准相关的地方政策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rising to the challenge: an international Delphi consensus study on fetal and neonatal alloimmune thrombocytopenia.

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a condition in which a fetus is at risk for severe thrombocytopenia, possibly resulting in intracranial haemorrhage, due to maternal alloantibodies formed against human platelet antigens (HPAs). Currently, no FNAIT screening programme exists. Pregnancies at risk of FNAIT are identified in individuals who have previously given birth to a child with FNAIT. Management of the condition differs depending on the country. A panel of experts in obstetrics, neonatology, paediatrics, laboratory and transfusion medicine, haematology, health technology assessments, and population screening-related administration who are members of the FNAIT Modified Delphi Expert Group from Europe, the USA, Canada, and Australia, were invited to participate in this study. This Delphi study included three rounds of online questionnaires, which were formulated by professionals from the Dutch FNAIT centre of expertise in collaboration with co-authors, and one live meeting in Leiden, the Netherlands in April, 2023. Funding for the live meeting in Leiden was obtained from the Dutch Research Council. The final questionnaire had 35 statements on current management and a possible antenatal FNAIT screening programme. Answer options were: agree, disagree, neither agree or disagree, and not sufficient knowledge. Consensus threshold was set at 80%. After three rounds of questionnaires, consensus was reached on 25 (71%) of 35 statements. The experts agreed on the use of anti-HPA-1a antibody levels to identify high-risk FNAIT pregnancies, although a cutoff value was not defined. The panel achieved consensus on the design of a cost-effective screening programme based only on anti-HPA-1a antibody level measurement. International differences were observed in case of two aspects: addition of corticosteroids to intravenous immunoglobulins and delivery mode in FNAIT pregnancies. This Delphi study facilitated sharing of international knowledge, which enabled clarification of local policies related to perceived standards of care.

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来源期刊
Lancet Haematology
Lancet Haematology HEMATOLOGY-
CiteScore
26.00
自引率
0.80%
发文量
323
期刊介绍: Launched in autumn 2014, The Lancet Haematology is part of the Lancet specialty journals, exclusively available online. This monthly journal is committed to publishing original research that not only sheds light on haematological clinical practice but also advocates for change within the field. Aligned with the Lancet journals' tradition of high-impact research, The Lancet Haematology aspires to achieve a similar standing and reputation within its discipline. It upholds the rigorous reporting standards characteristic of all Lancet titles, ensuring a consistent commitment to quality in its contributions to the field of haematology.
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