A new scientific review published in Blood highlights the latest advances in diagnosis, understanding of disease mechanisms and treatment strategies for fetal-neonatal alloimmune thrombocytopeniaThrombocytopenia A platelet count that is lower than normal. (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.).
This rare inherited disorder, in which a pregnant woman’s body develops antibodies that cross the placenta and destroy fetal platelets, affects about one in 1,000 pregnancies. It’s often not detected until birth when a newborn shows signs of bleeding.
However, the review notes that new testing methods are making it easier to identify pregnancies at risk of FNAIT earlier. For example, doctors can now use a simple blood test during pregnancy to analyze tiny fragments of the baby’s DNA circulating in the mother’s bloodstream. This helps determine whether the baby carries the platelet type that could trigger the condition.
Learn more about FNAIT testing and diagnosis
Researchers also identified a genetic marker, DRB3*01:01, that dramatically increases the likelihood of developing harmful antibodies in susceptible women. However, predicting how severe the disease will be remains difficult. Scientists now believe that the structure of the antibodies, rather than the sheer number of antibodies, may play a bigger role in how sick a baby becomes.
The review also emphasizes newly recognized FNAIT complications beyond bleeding. The antibodies may trigger placental inflammation, which has been linked to fetal growth restriction and long-term neurodevelopmental problems, including an increased risk of autism.
Current treatment for FNAIT includes platelet transfusions and intravenous immunoglobulinIntravenous immunoglobulin A treatment given to pregnant women with a history of FNAIT or known alloantibodies. IVIG reduces the immune reaction against fetal platelets. (IVIGIntravenous immunoglobulin A treatment given to pregnant women with a history of FNAIT or known alloantibodies. IVIG reduces the immune reaction against fetal platelets.) to boost fetal platelet counts. Researchers are also exploring therapies that block the neonatal Fc receptorFc receptor A specialized transport protein. In FNAIT, it carries maternal antiplatelet IgG antibodies across the placenta into the fetus, which destroys the fetus's platelets. (FcRnFc receptor A specialized transport protein. In FNAIT, it carries maternal antiplatelet IgG antibodies across the placenta into the fetus, which destroys the fetus's platelets.), which could reduce antibody transfer across the placenta.
Overall, the review calls for better predictive biomarkers and suggests universal screening and preventive strategies may ultimately help reduce the burden of FNAIT.
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