Fetal and neonatal alloimmune thrombocytopenia (FNAIT ) is a disorder that should be treated as soon as possible, given that patients are likely to face poor outcomes without therapeutic intervention, according to a review recently published in Transfusion Medicine and Hemotherapy.
Because FNAIT remains a relatively rare disorder that physicians may not be familiar with, a diagnosis is often established after birth, when a newborn demonstrates unusual signs of bleeding.
The most dangerous site at which hemorrhage in FNAIT can occur is the brain and is known as an intracranial hemorrhage. This is because the skull is a rigid structure, and any additional internal pressure secondary to sudden bleeding can cause lasting damage. The risk of ICH, as well as the risk of neurological impairment arising from an episode of ICH, should prompt physicians to be vigilant about this condition, regardless of the child’s platelet count, the authors wrote.
Platelet transfusions are among the most commonly used strategies for managing FNAIT. These recommendations were based largely on expert opinions; prospective studies in FNAIT are relatively scarce. Currently, there is scientific consensus that physicians should aim for a platelet count of at least 25 g/L if the mother had a previous pregnancy without ICH; if, however, a pregnancy history involving ICH was reported, physicians should aim for a platelet count of at least 50 g/L.
Read more about FNAIT testing and diagnosis
There has been much discussion regarding whether the introduction of a screening program would truly be beneficial in the sense that they justify the costs of the program setup. Even if a screening program is agreed to, there remains a lack of clarity about when and how best to carry it out. One suggestion was to screen patients who are between 20 and 27 weeks of gestation. If the anti-human platelet antigen (HPA)-1a antibody titer is greater than 3 IU/ML, weekly prophylaxis with intravenous immunoglobulin (IVIG) should be administered.
“Experienced multidisciplinary centers have a very high success rate in diagnosing and treating fetal and neonatal thrombocytopenia in the year 2025,” the authors of the study wrote. “There is an urgent need for better risk assessment in anti-HPA-1a-immunized pregnant women to implement FNAIT screening in regular antenatal care.”
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