A study recently published in Clinical and Experimental Obstetrics & Gynecology followed six pregnant women with severe primary immune thrombocytopenia (ITP) to monitor maternal and fetal outcomes.
In patients with ITP, the individual’s immune system mistakenly attacks their platelets, resulting in thrombocytopenia. Although ITP is a distinct condition from fetal and neonatal alloimmune thrombocytopenia (FNAIT), it can cause maternal hemorrhage, a risk factor for FNAIT. There have also been reported cases of maternal thrombocytopenia increasing the risk of infant thrombocytopenia.
The study included six pregnant women who were admitted to the hospital after 32 weeks gestation due to low platelet levels. For all individuals, this was their first pregnancy.
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.
Read more about the care team for FNAIT
Some participants had previously received a diagnosis of thrombocytopenia. Only one patient experienced symptoms of thrombocytopenia, namely bruising and nosebleeds.
For individuals with severe thrombocytopenia, platelet transfusions were administered. These patients also received intravenous immunoglobulin (IVIG) to help prevent platelet destruction, prednisone to suppress the immune system and thrombopoietin to promote platelet production.
Participants with less severe platelet counts received IVIG, prednisone and thrombopoietin, with some also needing platelet transfusions.
The authors highlighted one case that was considered extremely high risk to both the mother and fetus. This individual was hospitalized five times throughout her pregnancy because of her low platelet levels. She received platelet transfusions and prednisone but refused IVIG due to financial barriers.
All patients gave birth via cesarean section. The authors noted that pregnancy was prolonged for the safety of the baby when it was possible to do so.
All of the infants had positive outcomes. Because all were born prematurely, though, they were admitted to the neonatal intensive care unit for additional monitoring. One baby was diagnosed with moderate thrombocytopenia, while the rest had normal platelet levels. All were discharged after five to 10 days.
Maternal conditions also improved after discharge, with notable increases in platelet counts compared to initial levels.
“Individualized comprehensive treatment can effectively manage severe ITP during late pregnancy, with protocols tailored to each patient’s condition, gestational age, and platelet count fluctuations,” the study authors concluded.
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