An expert panel has compiled a set of guidelines for diagnosing and treating fetal and neonatal alloimmune thrombocytopenia (FNAIT) based on the opinions of international experts in the field, according to a report recently published in The Lancet Haematology
The report utilized the Delphi method, which consists of several rounds of surveys that are administered with the goal of achieving an expert-backed consensus.
The authors administered a questionnaire to a group of experts in FNAIT care. Utilizing the feedback and results from the first round, a revised questionnaire was administered along with a summary of results from the first round. This provided participants with the opportunity to revise their previous responses in the second round of questioning.
The authors then held a live meeting in which several FNAIT experts gathered in the Netherlands to share their knowledge and experience. Then, a final questionnaire was sent to participants to provide an additional opportunity to adjust responses.
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Findings revealed that while only 3.5% of the questionnaire statements achieved consensus after the first round, 57% of the statements reached consensus after the third round. Consensus was defined as 80% agreement or disagreement on a particular statement.
All of the participants recommended that pregnancies should be considered high-risk for FNAIT if the mother has anti-human platelet antigen-1a (HPA-1a) antibodies and a child with intracranial hemorrhage from a prior pregnancy.
The majority of experts also agreed that steroids should generally not be used in pregnant individuals who have developed an immune response against HPA-1a and had a child with FNAIT without intracranial hemorrhage. Additionally, 90% of participants supported the use of platelet transfusions that are matched based on the patient’s HPA type.
In regards to the development of a screening program for FNAIT, 87% of the experts agreed that such a program should not screen for cases of FNAIT caused by all types of antibodies due to cost considerations. For example, 86% recommended that a potential screening program should not include anti-HPA-5b antibodies in its evaluation.
“This modified Delphi method-based study facilitated international sharing of knowledge and establishing consensus regarding management of pregnancies at risk for FNAIT and designing a possible FNAIT screening programme,” the authors concluded.
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