When it comes to diagnosing and treating fetal and neonatal alloimmune thrombocytopenia (FNAITFetal and neonatal alloimmune thrombocytopenia A rare condition in which a mother’s immune system attacks fetal platelets, leading to dangerously low platelet levels before and/or after birth.), some hospitals might be better equipped than others. FNAIT is a complex and under-recognized disease, and not all facilities have the expertise needed to provide proper care.
Diagnostic tools used in FNAIT
In many cases, FNAIT isn’t detected until birth. However, a fetal ultrasound may detect bleeding or swelling, which may prompt further investigation. Healthcare practitioners must be trained to recognize these signs as potential manifestations of FNAIT.
One test that may be used either during or after pregnancy is a flow cytometry test, which tests for maternal antibodies that may be formed against fetal human platelet antigens (HPAHuman platelet antigen Proteins found on the surface of platelets. Incompatibility between maternal and fetal human platelet antigens can trigger FNAIT.) inherited from the father. This requires technologists who are trained to prepare samples, operate the instrument and interpret the data. Smaller and more rural hospitals don’t always have access to this level of expertise.
Read more about FNAIT testing and diagnosis
GenotypingGenotyping A laboratory test that identifies which platelet antigens a person carries. Often used to confirm HPA incompatibility and assess recurrence risk. can also be used to confirm a diagnosis of FNAIT. Because no standard screening program exists for FNAIT, though, some hospitals may only detect the disease if they are actively searching for it.
Need for multidisciplinary care teams
Collaboration between health care professionals of various backgrounds is critical for ensuring effective disease management. Members of the care team may include:
- Hematopathologists: These are doctors who specialize in the diagnosis of diseases affecting the blood, lymph nodes or bone marrow.
- Radiologists: Specialist radiologists can assist in reading results of ultrasound or magnetic resonance imaging tests to identify severe complications of FNAIT, such as intracranial hemorrhage.
- Maternal-fetal medicine specialists: These physicians often oversee patient care and direct individuals to other care team members as necessary.
- Infusion nurse specialists: Intravenous immunoglobulin (IVIG) is an off-label treatment for FNAIT that can be used during pregnancy to prevent bleeding complications. Infusion nurse specialists assist in the administration of IVIG.
- Transfusion specialists: Platelet transfusions may be needed to address severe thrombocytopenia Transfusion specialists assist in the selection of matched platelets.
Successful care of FNAIT doesn’t always require the involvement of all of these individuals. What’s more important is that you have a team that understands the condition and its complications and works closely with one another to manage your care.
Considerations when choosing a hospital
If you’re at risk for FNAIT or have recently received a diagnosis, selecting a hospital that is knowledgeable about FNAIT can help streamline your care.
When selecting a facility, you may want to prioritize locations that have experienced maternal-fetal medicine specialists, access to HPA-matched platelets and experience in administering IVIGIntravenous immunoglobulin A treatment given to pregnant women with a history of FNAIT or known alloantibodies. IVIG reduces the immune reaction against fetal platelets.. You may also want to choose a hospital with a higher-level neonatal intensive care unit (NICUNeonatal intensive care unit A specialized hospital unit for newborns who need close monitoring and treatments such as platelet transfusions.), as it may offer improved specialist care.
Frequent monitoring may also be needed, especially during pregnancy, so you should consider travel times when making your decision.
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