Platelet transfusions are a life-saving tool for patients with fetal and neonatal alloimmune thrombocytopenia (FNAIT), a disease caused when the proteins found on fetal and maternal platelets are incompatible with one another.
Most often administered after birth, platelet transfusions help to reduce thrombocytopenia among infants whose platelets were destroyed by maternal antibodies.
Given the current shortage in platelets worldwide, you may be concerned about the limited availability of matched platelets. While matched platelets are preferred for individuals with FNAIT, unmatched ones can also be used when necessary.
What is platelet matching in FNAIT?
Most cases of FNAIT arise when the baby inherits human platelet antigens (HPAs) from the father that the mother does not have. In response, the mother’s immune system recognizes those proteins are foreign and targets the platelets for destruction.
Read more about FNAIT treatment and care
Even after the baby is born, some of those maternal antibodies will remain in the body for at least the first few weeks after birth. Therefore, if the baby receives donated platelets that contain that same HPA, they are at risk of being targeted by the antibodies.
Matched platelets are those that don’t contain the HPA against which the maternal antibodies are primed, eliminating the chance of detection by maternal antibodies.
The current platelet shortage
Many countries around the world, including the United States, are currently facing platelet shortages. Several factors are contributing to this shortage, including:
- Platelet shelf life: Under standard storage conditions, donated platelets only last approximately five days.
- Low donor turnout: Only around 3% of those who are eligible to donate blood do so.
- High demand: In the United States alone, around 5,000 units of platelets are needed every day.
In the case of FNAIT, this may make finding perfectly matched platelets even more difficult.
Are matched platelets a requirement for FNAIT-affected babies?
Luckily, babies with FNAIT who need platelet transfusions don’t necessarily require matched platelets, though they are typically preferred to maximize effectiveness.
If HPA-matched platelets aren’t readily available, it’s completely normal for your health care team to instead recommend unmatched, also known as random, platelets. This can temporarily raise your baby’s platelet counts until matched ones are made available.
Delaying treatment versus using unmatched platelets
The decision of whether to wait for matched platelets or to use available resources will vary from case to case. If the patient’s thrombocytopenia is severe, the care team will likely administer unmatched platelets.
If platelet levels aren’t too low, on the other hand, and it is safe to wait, your providers may choose that route instead.
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