In babies affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT), there is a high risk of bleeding in the brain, lungs, eyes and gastrointestinal tract. Due to a lack of prenatal screening, FNAIT is most often diagnosed post-delivery. Severe complications of gastrointestinal bleeding are rare, but early diagnosis and treatment are essential to achieving the best outcomes.
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.
How is the gastrointestinal tract affected?
The gastrointestinal tract is the cavity between the chest and the pelvis. It is made up of the stomach, small intestine, colon (large bowel), liver, gallbladder and spleen. In FNAIT, it is the second most common part of the body to experience bleeding.
When the baby’s blood platelets are destroyed by maternal antibodies, thrombocytopenia develops, preventing the blood from clotting. The rupture of blood vessels or minor injuries can develop into bleeding and hemorrhage as a result.
Symptoms of gastrointestinal bleeding in FNAIT babies
Bleeding in the gastrointestinal tract in FNAIT-affected newborns is associated with the following symptoms:
- Blood in the stool
- Black, tarry stools caused by bacterial deterioration in the colon (known as melena)
- Vomiting up blood
- Abdominal swelling and discomfort
- Anemia
Learn more about FNAIT signs and symptoms
Treatment options for gastrointestinal bleeding
In cases of fetal FNAIT, gastrointestinal bleeding can be detected on ultrasound. First-line treatment during pregnancy involves administering intravenous immunoglobulin (IVIG) with or without steroids to the mother to suppress the maternal immune response. Early delivery may be necessary if bleeding worsens and puts the fetus’s life at risk.
In newborns suspected of FNAIT, a blood platelet transfusion is urgently required to increase the platelet count and stop the bleeding.
How to avoid gastrointestinal bleeding in FNAIT
The risk of developing FNAIT is usually not identified before it occurs, as there is no prenatal screening program. FNAIT is therefore only diagnosed during pregnancy if bleeding or hemorrhage is detected on an ultrasound. Early medical intervention is key to avoiding complications of severe fetal thrombocytopenia such as gastrointestinal bleeding.
Post-delivery, FNAIT is identified via symptoms such as bruising, skin discoloration with red or purple dots, low platelet levels and intracranial hemorrhage. Urgent treatment can help avoid worsening symptoms of thrombocytopenia that can lead to gastrointestinal bleeding.
A confirmed diagnosis of FNAIT in a first pregnancy will guide preparation and care during subsequent pregnancies. Close monitoring and preventative treatment can help delay or prevent the onset of severe thrombocytopenia.
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