Newborns with suspected fetal and neonatal alloimmune thrombocytopenia (FNAIT) are often treated with platelet transfusions to boost platelet levels and treat associated complications of thrombocytopenia.
However, to ensure the most effective treatment and avoid additional complications, your doctor may want to wait before initiating the first transfusion.
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.
When is FNAIT suspected in newborns?
Newborns may be suspected of FNAIT based on symptoms such as petechiae, or tiny red spots on the skin, purpura, or purple patches of skin discoloration, bruising, unexplained bleeding, hemorrhage, blood in stools and a low platelet count. Newborns can also exhibit lethargy, fatigue, fussiness and feeding difficulties.
To avoid long-term complications, treatment is initiated before FNAIT is confirmed, as the results of diagnostic tests can take up to a few weeks to come back.
Complications associated with platelet transfusions
While platelet transfusions have traditionally been given as urgent treatment for suspected FNAIT in newborns, their systematic use has recently been questioned. Complications have been associated with platelet transfusions in newborns with suspected FNAIT, notably neurodevelopmental delay, bronchopulmonary dysplasia, bleeding and death.
While more research is required to confirm the reasons behind these complications, caution has been recommended in administering platelet transfusions in newborns where platelet levels are low but there is no bleeding or hemorrhagic activity.
New guidelines from The American Association of Blood Banks (AABB) and the International Collaboration for Transfusion Medicine Guidelines (ICTMG) do recommend the use of platelet transfusions in preterm newborns if the platelet count falls below 25 x 103/μL
However, in the case of unexplained and uncontrolled bleeding and signs of intracranial hemorrhage in the newborn, platelet transfusions can be lifesaving and must be initiated without delay.
Why platelet transfusions may be delayed
There are two key reasons why a doctor may delay platelet transfusions in a newborn suspected of FNAIT.
Respecting latest guidelines or clinical advice.
FNAIT is a rare immune disorder and not commonly known by all doctors, so they need the time to consult the latest in research and clinical recommendations before ordering any procedures.
Waiting for matched platelets.
These are antigen-negative platelets and are either washed maternal platelets or HPA-matched donor platelets. They are considered the most effective for use in a platelet transfusion in suspected FNAIT.
As research continues and there is more awareness around FNAIT, treatment will continue to evolve.
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