Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a pregnancy condition in which the mother produces antibodies that target and destroy the platelets of the fetus. Platelets are an important group of red blood cells that stop bleeding.
If you have an internal or external injury, platelets are the first responders that arrive on the scene to seal off the wound to prevent the bleeding from causing more damage.
Once FNAIT is diagnosed, your doctor will monitor your pregnancy very closely, including after delivery to ensure that your child is in good health. This is because a lack of platelets can be dangerous as it can lead to severe bleeding, such as in the brain, which can in turn lead to death.
During pregnancy, your doctor has a number of therapies at their disposal in the event that treatment is necessary. One such therapy is platelet transfusions. As the name suggests, this is the transfusion of platelets to the fetus to replace the platelets that have been destroyed. However, in rare cases, platelet transfusions may not work, prompting the need for other interventions.
Why would platelet transfusions fail?
No treatment is guaranteed to succeed, and platelet transfusions are no different. In FNAIT, the mother’s immune system produces antibodies that target antigens on the fetal platelets, which are like unique markers that the antibodies can detect and identify. If the platelets used in the transfusion contain antigens of which the maternal antibodies were provoked to target in the first place, the same scenario might repeat itself, with the maternal antibodies destroying the newly transfused platelets.
Read more about FNAIT testing and diagnosis
If this scenario occurs, the platelet transfusion will not succeed, and the newly transfused platelets will be cleared away by the immune system. This can be quickly detected by doctors because they would have observed that the platelet levels have not sufficiently increased despite the transfusion having taken place. This means that the risk of bleeding remains.
Platelet transfusion alternatives
Fortunately, other treatment options exist. If antigen mismatch was the cause of transfusion failure, your doctor has the option of using antigen-negative platelets for transfusion. These can be sourced from specific donors or from the mother herself.
Other commonly used therapies in FNAIT include intravenous immunoglobulin, which is used to reduce the destruction of platelets by maternal antibodies. Another method to suppress the maternal immune system is by administering corticosteroids, which is a longstanding method to achieve this purpose.
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