Fetal and neonatal alloimmune thrombocytopenia (FNAIT) and disseminated intravascular coagulation (DIC) can both affect blood platelets and cause similar symptoms, but they are separate conditions with different treatments.
In an obstetric setting, early detection and accurate diagnosis plus timely medical treatment are essential to the best outcomes for the mother and baby.
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What is DIC and what are its causes?
DIC is an acute complication of certain life-threatening medical conditions. It can lead to blood clots and compromised blood flow, resulting in bleeding and organ failure. It can be triggered by health conditions such as sepsis, infection, liver disease, snake bites, pancreatitis, trauma and blood cancer.
In pregnancy and post-delivery, it can affect the mother and baby, and may be caused by acute fatty liver, placental abruption, postpartum hemorrhageFetal hemorrhage Any bleeding that occurs before birth. In FNAIT, this usually results from extremely low platelet counts., preeclampsia, amniotic fluid embolism and Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome.
Symptoms may include uncontrolled bleeding, bruising, fever, difficulty breathing or cognitive difficulties. Rates of obstetrical DIC can range from 0.03% in North America to 0.35% in developing countries.
How is DIC diagnosed?
A diagnosis of DIC is not always straightforward, as there is a lack of awareness of DIC among the medical community. Sometimes, it is diagnosed too late for meaningful treatment, once the patient is experiencing uncontrolled hemorrhaging or multi-organ failure.
Once DIC is suspected, the following tests can confirm diagnosis:
Full blood count: A test that determines the levels of platelets in the blood.
Partial thromboplastin time: A blood test which measures the time it takes for blood to clot.
Prothrombin time: A test performed alongside a partial thromboplastin time that measures how long it takes a blood sample to clot.
Fibrinogen test: A blood test that measures fibrinogen levels in the blood, a blood protein that helps your blood clot.
D-dimer test: A blood test that measures D-dimer levels in the blood, a protein fragment that supports blood clotting.
Learn more about FNAIT testing and diagnosis
FNAIT vs DIC in an obstetric setting
While these two conditions both affect the way blood clots and can lead to uncontrollable hemorrhaging and permanent damage or death, in is important to urgently differentiate between them. In an obstetric setting, the following differences are key
In FNAIT, a maternal immune response destroys fetal platelets, while DIC is a complication of health condition leading to abnormal clot formation and excessive bleeding.
In FNAIT, the baby’s platelets are low, but maternal platelets are normal and a newborn presents with unexplained thrombocytopeniaThrombocytopenia A platelet count that is lower than normal.. In comparison, in cases of DIC, the baby’s platelets are very low, and maternal platelets are not relevant, while a newborn is clearly critically ill and has uncontrolled bleeding and bruising.
Urgent treatment of suspected FNAIT in newborns involves platelet transfusionPlatelet transfusion A treatment for newborns with very low platelet counts that ideally uses HPA-compatible or washed maternal platelets., and treating DIC involves identifying and treating the underlying trigger or cause.
