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Intravenous immunoglobulin G in women with reproductive failure: The Korean Society for Reproductive Immunology practice guidelines

  • Sung, Nayoung (Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital) ;
  • Han, Ae Ra (Department of Obstetrics and Gynecology, Gangseo Mizmedi Hospital) ;
  • Park, Chan Woo (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine) ;
  • Park, Dong Wook (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine) ;
  • Park, Joon Cheol (Department of Obstetrics and Gynecology, Keimyung University School of Medicine) ;
  • Kim, Na Young (Department of Obstetrics and Gynecology, Gangnam Mizmedi Hospital) ;
  • Lim, Kyung Sil (Maria Fertility Hospital) ;
  • Shin, Ji Eun (Maria Fertility Hospital) ;
  • Joo, Chang Woo (Maria Fertility Hospital) ;
  • Lee, Seung Eun (Department of Obstetrics and Gynecology, Bundang CHA Medical Center, CHA University) ;
  • Kim, Jae Won (Seoul Rachel Fertility Center) ;
  • Lee, Sung Ki (Department of Obstetrics and Gynecology, Konyang University College of Medicine) ;
  • IVIG Task Force Korean Society for Reproductive Immunology (Korean Society for Reproductive Immunology)
  • Received : 2016.12.28
  • Accepted : 2017.01.25
  • Published : 2017.03.31

Abstract

The task force of the Korean Society for Reproductive Immunology recommends intravenous immunoglobulin G treatment in women with reproductive failure, including recurrent pregnancy loss and/or repeated implantation failure, who show cellular immune factors such as abnormal natural killer cell levels, natural killer cell cytotoxicity, and/or type 1 T helper immunity.

Keywords

References

  1. Saito S, Nakashima A, Shima T, Ito M. Th1/Th2/Th17 and regulatory T-cell paradigm in pregnancy. Am J Reprod Immunol 2010; 63:601-10. https://doi.org/10.1111/j.1600-0897.2010.00852.x
  2. Kwak-Kim JY, Chung-Bang HS, Ng SC, Ntrivalas EI, Mangubat CP, Beaman KD, et al. Increased T helper 1 cytokine responses by circulating T cells are present in women with recurrent pregnancy losses and in infertile women with multiple implantation failures after IVF. Hum Reprod 2003;18:767-73. https://doi.org/10.1093/humrep/deg156
  3. Aoki K, Kajiura S, Matsumoto Y, Ogasawara M, Okada S, Yagami Y, et al. Preconceptional natural-killer-cell activity as a predictor of miscarriage. Lancet 1995;345:1340-2. https://doi.org/10.1016/S0140-6736(95)92539-2
  4. Fukui A, Fujii S, Yamaguchi E, Kimura H, Sato S, Saito Y. Natural killer cell subpopulations and cytotoxicity for infertile patients undergoing in vitro fertilization. Am J Reprod Immunol 1999;41: 413-22. https://doi.org/10.1111/j.1600-0897.1999.tb00456.x
  5. Lee SK, Kim JY, Hur SE, Kim CJ, Na BJ, Lee M, et al. An imbalance in interleukin-17-producing T and Foxp3+ regulatory T cells in women with idiopathic recurrent pregnancy loss. Hum Reprod 2011;26:2964-71. https://doi.org/10.1093/humrep/der301
  6. Kwak JY, Beaman KD, Gilman-Sachs A, Ruiz JE, Schewitz D, Beer AE. Up-regulated expression of CD56+, CD56+/CD16+, and CD19+ cells in peripheral blood lymphocytes in pregnant women with recurrent pregnancy losses. Am J Reprod Immunol 1995; 34:93-9. https://doi.org/10.1111/j.1600-0897.1995.tb00924.x
  7. Emmer PM, Nelen WL, Steegers EA, Hendriks JC, Veerhoek M, Joosten I. Peripheral natural killer cytotoxicity and CD56(pos) CD16(pos) cells increase during early pregnancy in women with a history of recurrent spontaneous abortion. Hum Reprod 2000; 15:1163-9. https://doi.org/10.1093/humrep/15.5.1163
  8. Lee SK, Na BJ, Kim JY, Hur SE, Lee M, Gilman-Sachs A, et al. Determination of clinical cellular immune markers in women with recurrent pregnancy loss. Am J Reprod Immunol 2013;70:398-411.
  9. Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Rev Obstet Gynecol 2009;2:76-83.
  10. Perricone C, De Carolis C, Giacomelli R, Zaccari G, Cipriani P, Bizzi E, et al. High levels of NK cells in the peripheral blood of patients affected with anti-phospholipid syndrome and recurrent spontaneous abortion: a potential new hypothesis. Rheumatology (Oxford) 2007;46:1574-8. https://doi.org/10.1093/rheumatology/kem197
  11. Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertil Steril 2010;93:1234-43. https://doi.org/10.1016/j.fertnstert.2009.01.166
  12. Buckingham KL, Chamley LW. A critical assessment of the role of antiphospholipid antibodies in infertility. J Reprod Immunol 2009;80:132-45. https://doi.org/10.1016/j.jri.2008.11.005
  13. Imbach P, Barandun S, d’Apuzzo V, Baumgartner C, Hirt A, Morell A, et al. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Lancet 1981;1:1228-31.
  14. Ruiz JE, Cubillos J, Mendoza JC, Espinel FJ, Kwak JY, Beer AE. Autoantibodies to phospholipids and nuclear antigens in nonpregnant and pregnant Colombian women with recurrent spontaneous abortions. J Reprod Immunol 1995;28:41-51. https://doi.org/10.1016/0165-0378(94)00906-N
  15. Coulam CB, Krysa L, Stern JJ, Bustillo M. Intravenous immunoglobulin for treatment of recurrent pregnancy loss. Am J Reprod Immunol 1995;34:333-7. https://doi.org/10.1111/j.1600-0897.1995.tb00960.x
  16. Ruiz JE, Kwak JY, Baum L, Gilman-Sachs A, Beaman KD, Kim YB, et al. Intravenous immunoglobulin inhibits natural killer cell activity in vivo in women with recurrent spontaneous abortion. Am J Reprod Immunol 1996;35:370-5. https://doi.org/10.1111/j.1600-0897.1996.tb00496.x
  17. Carp HJ, Ahiron R, Mashiach S, Schonfeld Y, Gazit E, Toder V. Intravenous immunoglobulin in women with five or more abortions. Am J Reprod Immunol 1996;35:360-2. https://doi.org/10.1111/j.1600-0897.1996.tb00494.x
  18. Intravenous immunoglobulin in the prevention of recurrent miscarriage: the German RSA/IVIG group. Br J Obstet Gynaecol 1994;101:1072-7. https://doi.org/10.1111/j.1471-0528.1994.tb13584.x
  19. Stephenson MD, Kutteh WH, Purkiss S, Librach C, Schultz P, Houlihan E, et al. Intravenous immunoglobulin and idiopathic secondary recurrent miscarriage: a multicentered randomized placebo- controlled trial. Hum Reprod 2010;25:2203-9. https://doi.org/10.1093/humrep/deq179
  20. Christiansen OB, Larsen EC, Egerup P, Lunoee L, Egestad L, Nielsen HS. Intravenous immunoglobulin treatment for secondary recurrent miscarriage: a randomised, double-blind, placebocontrolled trial. BJOG 2015;122:500-8. https://doi.org/10.1111/1471-0528.13192
  21. Ata B, Tan SL, Shehata F, Holzer H, Buckett W. A systematic review of intravenous immunoglobulin for treatment of unexplained recurrent miscarriage. Fertil Steril 2011;95:1080-5.e1-2. https://doi.org/10.1016/j.fertnstert.2010.12.021
  22. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS consensus workshop group. Fertil Steril 2012;97:28-38. e25. https://doi.org/10.1016/j.fertnstert.2011.09.024
  23. Stirrat GM. Recurrent miscarriage. Lancet 1990;336:673-5. https://doi.org/10.1016/0140-6736(90)92159-F
  24. Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril 2013;99:63. https://doi.org/10.1016/j.fertnstert.2012.09.023
  25. Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril 2012;98:1103-11. https://doi.org/10.1016/j.fertnstert.2012.06.048
  26. Stephenson MD. Frequency of factors associated with habitual abortion in 197 couples. Fertil Steril 1996;66:24-9. https://doi.org/10.1016/S0015-0282(16)58382-4
  27. Tulppala M, Palosuo T, Ramsay T, Miettinen A, Salonen R, Ylikorkala O. A prospective study of 63 couples with a history of recurrent spontaneous abortion: contributing factors and outcome of subsequent pregnancies. Hum Reprod 1993;8:764-70. https://doi.org/10.1093/oxfordjournals.humrep.a138137
  28. Hutton B, Sharma R, Fergusson D, Tinmouth A, Hebert P, Jamieson J, et al. Use of intravenous immunoglobulin for treatment of recurrent miscarriage: a systematic review. BJOG 2007;114:134-42. https://doi.org/10.1111/j.1471-0528.2006.01201.x
  29. Kwak JY, Kwak FM, Ainbinder SW, Ruiz AM, Beer AE. Elevated peripheral blood natural killer cells are effectively downregulated by immunoglobulin G infusion in women with recurrent spontaneous abortions. Am J Reprod Immunol 1996;35:363-9. https://doi.org/10.1111/j.1600-0897.1996.tb00495.x
  30. Graphou O, Chioti A, Pantazi A, Tsukoura C, Kontopoulou V, Guorgiadou E, et al. Effect of intravenous immunoglobulin treatment on the Th1/Th2 balance in women with recurrent spontaneous abortions. Am J Reprod Immunol 2003;49:21-9. https://doi.org/10.1034/j.1600-0897.2003.01169.x
  31. Yamada H, Morikawa M, Furuta I, Kato EH, Shimada S, Iwabuchi K, et al. Intravenous immunoglobulin treatment in women with recurrent abortions: increased cytokine levels and reduced Th1/Th2 lymphocyte ratio in peripheral blood. Am J Reprod Immunol 2003;49:84-9. https://doi.org/10.1034/j.1600-0897.2003.01184.x
  32. Perricone R, Di Muzio G, Perricone C, Giacomelli R, De Nardo D, Fontana L, et al. High levels of peripheral blood NK cells in women suffering from recurrent spontaneous abortion are reverted from high-dose intravenous immunoglobulins. Am J Reprod Immunol 2006;55:232-9. https://doi.org/10.1111/j.1600-0897.2005.00356.x
  33. Morikawa M, Yamada H, Kato EH, Shimada S, Kishi T, Yamada T, et al. Massive intravenous immunoglobulin treatment in women with four or more recurrent spontaneous abortions of unexplained etiology: down-regulation of NK cell activity and subsets. Am J Reprod Immunol 2001;46:399-404. https://doi.org/10.1034/j.1600-0897.2001.d01-31.x
  34. van den Heuvel MJ, Peralta CG, Hatta K, Han VK, Clark DA. Decline in number of elevated blood CD3(+) CD56(+) NKT cells in response to intravenous immunoglobulin treatment correlates with successful pregnancy. Am J Reprod Immunol 2007;58:447-59. https://doi.org/10.1111/j.1600-0897.2007.00529.x
  35. Moraru M, Carbone J, Alecsandru D, Castillo-Rama M, Garcia-Segovia A, Gil J, et al. Intravenous immunoglobulin treatment increased live birth rate in a Spanish cohort of women with recurrent reproductive failure and expanded CD56(+) cells. Am J Reprod Immunol 2012;68:75-84. https://doi.org/10.1111/j.1600-0897.2012.01135.x
  36. Lee SK, Kim JY, Han AR, Hur SE, Kim CJ, Kim TH, et al. Intravenous immunoglobulin G improves pregnancy outcome in women with recurrent pregnancy losses with cellular immune abnormalities. Am J Reprod Immunol 2016;75:59-68. https://doi.org/10.1111/aji.12442
  37. Kim DJ, Lee SK, Kim JY, Na BJ, Hur SE, Lee M, et al. Intravenous immunoglobulin G modulates peripheral blood Th17 and Foxp3(+) regulatory T cells in pregnant women with recurrent pregnancy loss. Am J Reprod Immunol 2014;71:441-50. https://doi.org/10.1111/aji.12208
  38. Clark DA, Wong K, Banwatt D, Chen Z, Liu J, Lee L, et al. CD200-dependent and nonCD200-dependent pathways of NK cell suppression by human IVIG. J Assist Reprod Genet 2008;25:67-72. https://doi.org/10.1007/s10815-008-9202-9
  39. Triolo G, Ferrante A, Ciccia F, Accardo-Palumbo A, Perino A, Castelli A, et al. Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies. Arthritis Rheum 2003;48:728-31. https://doi.org/10.1002/art.10957
  40. Dendrinos S, Sakkas E, Makrakis E. Low-molecular-weight heparin versus intravenous immunoglobulin for recurrent abortion associated with antiphospholipid antibody syndrome. Int J Gynaecol Obstet 2009;104:223-5. https://doi.org/10.1016/j.ijgo.2008.11.010
  41. Daya S, Gunby J, Porter F, Scott J, Clark DA. Critical analysis of intravenous immunoglobulin therapy for recurrent miscarriage. Hum Reprod Update 1999;5:475-82. https://doi.org/10.1093/humupd/5.5.475
  42. Christiansen OB, Pedersen B, Rosgaard A, Husth M. A randomized, double-blind, placebo-controlled trial of intravenous immunoglobulin in the prevention of recurrent miscarriage: evidence for a therapeutic effect in women with secondary recurrent miscarriage. Hum Reprod 2002;17:809-16. https://doi.org/10.1093/humrep/17.3.809
  43. Vaquero E, Lazzarin N, Valensise H, Menghini S, Di Pierro G, Cesa F, et al. Pregnancy outcome in recurrent spontaneous abortion associated with antiphospholipid antibodies: a comparative study of intravenous immunoglobulin versus prednisone plus low-dose aspirin. Am J Reprod Immunol 2001;45:174-9. https://doi.org/10.1111/j.8755-8920.2001.450309.x
  44. Margalioth EJ, Ben-Chetrit A, Gal M, Eldar-Geva T. Investigation and treatment of repeated implantation failure following IVF-ET. Hum Reprod 2006;21:3036-43. https://doi.org/10.1093/humrep/del305
  45. Penzias AS. Recurrent IVF failure: other factors. Fertil Steril 2012; 97:1033-8. https://doi.org/10.1016/j.fertnstert.2012.03.017
  46. Coughlan C, Ledger W, Wang Q, Liu F, Demirol A, Gurgan T, et al. Recurrent implantation failure: definition and management. Reprod Biomed Online 2014;28:14-38. https://doi.org/10.1016/j.rbmo.2013.08.011
  47. Gelbaya TA, Kyrgiou M, Li TC, Stern C, Nardo LG. Low-dose aspirin for in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update 2007;13:357-64. https://doi.org/10.1093/humupd/dmm005
  48. Dirckx K, Cabri P, Merien A, Galajdova L, Gerris J, Dhont M, et al. Does low-dose aspirin improve pregnancy rate in IVF/ICSI? A randomized double-blind placebo controlled trial. Hum Reprod 2009;24:856-60.
  49. Stern C, Chamley L, Norris H, Hale L, Baker HW. A randomized, double-blind, placebo-controlled trial of heparin and aspirin for women with in vitro fertilization implantation failure and antiphospholipid or antinuclear antibodies. Fertil Steril 2003;80: 376-83. https://doi.org/10.1016/S0015-0282(03)00610-1
  50. Stephenson MD, Fluker MR. Treatment of repeated unexplained in vitro fertilization failure with intravenous immunoglobulin: a randomized, placebo-controlled Canadian trial. Fertil Steril 2000;74:1108-13. https://doi.org/10.1016/S0015-0282(00)01622-8
  51. Li J, Chen Y, Liu C, Hu Y, Li L. Intravenous immunoglobulin treatment for repeated IVF/ICSI failure and unexplained infertility: a systematic review and a meta-analysis. Am J Reprod Immunol 2013;70:434-47. https://doi.org/10.1111/aji.12170
  52. Virro MR, Winger EE, Reed JL. Intravenous immunoglobulin for repeated IVF failure and unexplained infertility. Am J Reprod Immunol 2012;68:218-25. https://doi.org/10.1111/j.1600-0897.2012.01169.x
  53. Heilmann L, Schorsch M, Hahn T. CD3-CD56+CD16+ natural killer cells and improvement of pregnancy outcome in IVF/ICSI failure after additional IVIG-treatment. Am J Reprod Immunol 2010; 63:263-5. https://doi.org/10.1111/j.1600-0897.2009.00790.x
  54. Coulam CB, Goodman C. Increased pregnancy rates after IVF/ET with intravenous immunoglobulin treatment in women with elevated circulating C56+ cells. Early Pregnancy 2000;4:90-8.
  55. De Placido G, Zullo F, Mollo A, Cappiello F, Nazzaro A, Colacurci N, et al. Intravenous immunoglobulin (IVIG) in the prevention of implantation failures. Ann N Y Acad Sci 1994;734:232-4. https://doi.org/10.1111/j.1749-6632.1994.tb21751.x
  56. Thum MY, Bhaskaran S, Abdalla HI, Ford B, Sumar N, Bansal A. Prednisolone suppresses NK cell cytotoxicity in vitro in women with a history of infertility and elevated NK cell cytotoxicity. Am J Reprod Immunol 2008;59:259-65. https://doi.org/10.1111/j.1600-0897.2007.00574.x
  57. Thum MY, Bhaskaran S, Abdalla HI, Ford B, Sumar N, Shehata H, et al. An increase in the absolute count of CD56dim CD16+ CD69+ NK cells in the peripheral blood is associated with a poorer IVF treatment and pregnancy outcome. Hum Reprod 2004;19:2395-400. https://doi.org/10.1093/humrep/deh378
  58. Rai R, Sacks G, Trew G. Natural killer cells and reproductive failure: theory, practice and prejudice. Hum Reprod 2005;20:1123-6. https://doi.org/10.1093/humrep/deh804
  59. Miko E, Manfai Z, Meggyes M, Barakonyi A, Wilhelm F, Varnagy A, et al. Possible role of natural killer and natural killer T-like cells in implantation failure after IVF. Reprod Biomed Online 2010;21: 750-6. https://doi.org/10.1016/j.rbmo.2010.07.012
  60. Winger EE, Reed JL, Ashoush S, El-Toukhy T, Ahuja S, Taranissi M. Elevated preconception CD56+ 16+ and/or Th1:Th2 levels predict benefit from IVIG therapy in subfertile women undergoing IVF. Am J Reprod Immunol 2011;66:394-403. https://doi.org/10.1111/j.1600-0897.2011.01018.x
  61. Ramos-Medina R, Garcia-Segovia A, Gil J, Carbone J, Aguaron de la Cruz A, Seyfferth A, et al. Experience in IVIg therapy for selected women with recurrent reproductive failure and NK cell expansion. Am J Reprod Immunol 2014;71:458-66. https://doi.org/10.1111/aji.12217
  62. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 2011;342:d2616. https://doi.org/10.1136/bmj.d2616
  63. Ticconi C, Rotondi F, Veglia M, Pietropolli A, Bernardini S, Ria F, et al. Antinuclear autoantibodies in women with recurrent pregnancy loss. Am J Reprod Immunol 2010;64:384-92. https://doi.org/10.1111/j.1600-0897.2010.00863.x
  64. Carp HJ, Selmi C, Shoenfeld Y. The autoimmune bases of infertility and pregnancy loss. J Autoimmun 2012;38:J266-74. https://doi.org/10.1016/j.jaut.2011.11.016
  65. Perricone R, De Carolis C, Kroegler B, Greco E, Giacomelli R, Cipriani P, et al. Intravenous immunoglobulin therapy in pregnant patients affected with systemic lupus erythematosus and recurrent spontaneous abortion. Rheumatology (Oxford) 2008;47: 646-51. https://doi.org/10.1093/rheumatology/ken046
  66. Spinnato JA, Clark AL, Pierangeli SS, Harris EN. Intravenous immunoglobulin therapy for the antiphospholipid syndrome in pregnancy. Am J Obstet Gynecol 1995;172(2 Pt 1):690-4. https://doi.org/10.1016/0002-9378(95)90595-2
  67. Beer AE, Kwak JY, Ruiz JE. Immunophenotypic profiles of peripheral blood lymphocytes in women with recurrent pregnancy losses and in infertile women with multiple failed in vitro fertilization cycles. Am J Reprod Immunol 1996;35:376-82. https://doi.org/10.1111/j.1600-0897.1996.tb00497.x
  68. King K, Smith S, Chapman M, Sacks G. Detailed analysis of peripheral blood natural killer (NK) cells in women with recurrent miscarriage. Hum Reprod 2010;25:52-8. https://doi.org/10.1093/humrep/dep349
  69. Kwak JY, Gilman-Sachs A, Moretti M, Beaman KD, Beer AE. Natural killer cell cytotoxicity and paternal lymphocyte immunization in women with recurrent spontaneous abortions. Am J Reprod Immunol 1998;40:352-8. https://doi.org/10.1111/j.1600-0897.1998.tb00065.x
  70. Sherer Y, Levy Y, Shoenfeld Y. IVIG in autoimmunity and cancer: efficacy versus safety. Expert Opin Drug Saf 2002;1:153-8. https://doi.org/10.1517/14740338.1.2.153
  71. Burks AW, Sampson HA, Buckley RH. Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia: detection of IgE antibodies to IgA. N Engl J Med 1986;314:560-4. https://doi.org/10.1056/NEJM198602273140907
  72. Rachid R, Bonilla FA. The role of anti-IgA antibodies in causing adverse reactions to gamma globulin infusion in immunodeficient patients: a comprehensive review of the literature. J Allergy Clin Immunol 2012;129:628-34. https://doi.org/10.1016/j.jaci.2011.06.047
  73. Zhang R, Szerlip HM. Reemergence of sucrose nephropathy: acute renal failure caused by high-dose intravenous immune globulin therapy. South Med J 2000;93:901-4.
  74. Thornton CA, Ballow M. Safety of intravenous immunoglobulin. Arch Neurol 1993;50:135-6. https://doi.org/10.1001/archneur.1993.00540020013009
  75. Rauova L, Rovensky J, Shoenfeld Y. High dose intravenous immunoglobulins: a new step in the treatment of systemic lupus erythematosus. Isr Med Assoc J 2000;2:388-92.
  76. Dalakas MC. Intravenous immune globulin therapy for neurologic diseases. Ann Intern Med 1997;126:721-30. https://doi.org/10.7326/0003-4819-126-9-199705010-00008
  77. Kinney J, Mundorf L, Gleason C, Lee C, Townsend T, Thibault R, et al. Efficacy and pharmacokinetics of intravenous immune globulin administration to high-risk neonates. Am J Dis Child 1991; 145:1233-8.
  78. Ohlsson A, Lacy J. Intravenous immunoglobulin for suspected or subsequently proven infection in neonates. Cochrane Database Syst Rev 2010;(3):CD001239.
  79. Radder CM, Roelen DL, van de Meer-Prins EM, Claas FH, Kanhai HH, Brand A. The immunologic profile of infants born after maternal immunoglobulin treatment and intrauterine platelet transfusions for fetal/neonatal alloimmune thrombocytopenia. Am J Obstet Gynecol 2004;191:815-20. https://doi.org/10.1016/j.ajog.2004.02.002

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