Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disorder in which a pregnant woman produces antibodies that attack a type of blood cell in the fetus known as platelets, which are responsible for stopping bleeding. A decrease in the levels of platelets makes the fetus, and later the newborn child, vulnerable to bleeding episodes, which can be fatal.
Platelets stop bleeding by aggregating at the site of injury and forming a clot. Platelet glycoprotein such as GPIIb/IIIa are essential for this process. Specifically, they are responsible for binding fibrinogen (which form a mesh-like protective layer to stop bleeding) and von Willebrand factor, which is involved in the intricate process of clot formation.
In FNAIT, GPIIb/IIIa is targeted, leading to a situation in which the body cannot form clots to stop bleeding in a timely manner. This creates a perfect storm in which even tiny episodes of bleeding continue for longer than normal. This is why newborns with FNAIT are often found to have bruises. If bleeding occurs in the brain, a condition known as intracranial hemorrhage, it may be life-threatening.
Preventing severe complications
To prevent the clotting process from being disrupted, it is important that FNAIT is diagnosed as early as possible. An early diagnosis allows doctors to closely monitor the pregnancy and administer treatment that can help prevent severe bleeding complications from occurring.
The problem, however, is that FNAIT is not routinely screened for during pregnancy. FNAIT is a very rare disorder and is not typically suspected unless a patient had a previous pregnancy in which the newborn had unexplained bruising or bleeding, or if the patient was previously diagnosed with FNAIT.
Read more about FNAIT testing and diagnosis
The best way to increase the odds that FNAIT is picked up on is to not miss any prenatal appointments. This is because fetal ultrasound can sometimes detect signs of bleeding, prompting further clinical investigations. Typically, doctors will seek to rule out more common causes before screening for FNAIT. If FNAIT is suspected, doctors can test the mother for relevant antibodies. The direct measurement of fetal platelet levels are typically not carried out due to the invasive nature of this procedure, which may harm the fetus.
If you think you may be at risk of FNAIT, talk to your OB-GYN, who will be able to take appropriate steps to ensure you are monitored and treated throughout your pregnancy.
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