A pediatric hematologist is part of the multidisciplinary healthcare team that will care for you following a diagnosis of fetal and neonatal alloimmune thrombocytopenia (FNAIT) in your baby.
As a specialist in blood disorders in children, the pediatric hematologist will diagnose, treat and manage complications of FNAIT. In future pregnancies, when the risk of recurrence is high, their role is to advise on what to expect and how to manage the risk of FNAIT to prevent its onset.
What is FNAIT?
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare but serious condition that affects 0.1% of pregnancies in which a pregnant mother’s immune system produces antibodies against the platelets of her fetus. This occurs when a fetus inherits platelet antigens from the father that are not compatible with the mother, typically involving a protein called human platelet antigen (HPA). The mother’s immune system recognizes the fetal platelets as foreign, attacking and destroying them, leading to low platelet levels (thrombocytopenia) in the fetus or newborn.
What is a pediatric hematologist?
A pediatric hematologist is a specialist in diagnosing and treating blood disorders in children. The scope of a pediatric hematologist is quite large, covering anemia, hemophilia and cancers such as leukemia, brain tumors, bone tumors and solid tumors. Blood disorders that affect white blood cells and red blood cells, as well as platelets are also included. As a blood disorder that affects the platelets of the fetus or newborn, FNAIT requires the expertise of a pediatric hematologist.
Learn more about the FNAIT care team
The multidisciplinary healthcare team in FNAIT
Coordinated by the maternal-fetal specialist, the team of healthcare providers involved in the management of FNAIT may include radiologists, anesthetists, infusion nurse specialists, obstetricians, pediatric hematologists and neonatologists. If complications occur, the specialist care of neurologists and neuropsychologists may also be necessary.
The role of the pediatric hematologist
When a newborn presents with thrombocytopenia and is suspected of FNAIT, blood tests will confirm the platelet counts, then urgent treatment by platelet transfusion is required to ensure the best outcomes. If bleeding on the brain is detected, the risk of long-term neurodevelopmental problems is high. There is also the risk of hemorrhage occurring in other organs. Ultrasounds will be ordered to identify and monitor any internal bleeding.
The pediatric hematologist is responsible for assessing the newborn and deciding on the treatment protocol, namely platelet transfusions to increase the baby’s platelet levels. In parallel, he or she will order diagnostic testing to confirm the diagnosis of FNAIT. This involves genotyping of the mother, father and newborn. Treatment management by the pediatric hematologist will be focused on preventing complications and any long-term consequences for the baby.
When the newborn recovers and is able to leave hospital, the pediatric hematologist will schedule follow-up appointments to monitor for any lasting effects of FNAIT.
Pediatric hematologists and subsequent pregnancies
There is a 90% chance of FNAIT recurring in subsequent pregnancies. When preparing for future pregnancies, the advice of a pediatric hematologist will be valuable in planning for prenatal care and risk management. A treatment plan can be defined to delay the onset of thrombocytopenia and prevent complications.
