Most cases of fetal and neonatal alloimmune thrombocytopenia (FNAITFetal and neonatal alloimmune thrombocytopenia A rare condition in which a mother’s immune system attacks fetal platelets, leading to dangerously low platelet levels before and/or after birth.) are self-limiting, with mild symptoms that resolve quickly and have no long-term impact for the affected infant.
However, thrombocytopeniaThrombocytopenia A platelet count that is lower than normal. in newborns can cause symptoms that require urgent treatment to ensure positive outcomes. In addition to more visible symptoms of bruising of the skin, unexplained bleeding, internal hemorrhages and low platelet levels, temporary liver injury and enlargement can also occur.
How is liver function affected?
Very low platelet levels or severe thrombocytopeniaSevere thrombocytopenia A dangerously low platelet count, typically below 50,000 platelets per microliter and sometimes far lower in FNAIT. can cause blood vessels in the body to become fragile and at risk of injury. As a result, bleeding and inflammation can occur in organs like the liver.
Injury to the liver can cause it to become enlarged and lead to liver dysfunction. Jaundice or yellowing of the skin or eyes is a clear indication of the liver being affected, as it means bilirubin has accumulated and can be difficult to eliminate.
Learn more about FNAIT signs and symptoms
How is liver dysfunction detected?
In newborns suspected of FNAIT, a doctor may order a full blood count to check for platelet levels, red and white blood cells counts, as well as assessing liver function.
The following aspects of liver function are tested by analyzing a blood sample taken from the newborn:
· Bilirubin levels: High bilirubin levels cause jaundice. In FNAIT-affected newborns, internal bleeding or hemorrhage can be the reason for high levels of bilirubin. The baby’s immature liver has trouble eliminating the bilirubin.
· Liver enzymes (ALT and AST): These can rise if the liver is stressed, injured or inflamed. If elevated they need to be monitored, but will usually go back to normal levels when thrombocytopenia is treated.
How is liver dysfunction treated?
Internal bleedingFetal hemorrhage Any bleeding that occurs before birth. In FNAIT, this usually results from extremely low platelet counts. or hemorrhageFetal hemorrhage Any bleeding that occurs before birth. In FNAIT, this usually results from extremely low platelet counts. that can cause liver dysfunction is due to thrombocytopenia. Low platelet levels cause the blood to lose its ability to clot, leading to uncontrollable bleeding.
When the range of symptoms of thrombocytopenia are recognized, immediate treatment by platelet transfusionPlatelet transfusion A treatment for newborns with very low platelet counts that ideally uses HPA-compatible or washed maternal platelets. will be initiated. This boosts platelet levels and gradually resolves symptoms. The effects of previous incidents of bleeding such as jaundice may take some time to clear.
Jaundice resulting from internal bleeding or liver injury is treated with phototherapy to help break down the bilirubin in the blood, making it easier for the newborn’s liver to process it.
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