Routine screening during pregnancy for fetal and neonatal alloimmune thrombocytopenia (FNAIT) would allow for timely treatment and prevent brain bleeding in babies, according to a recent review published in the journal Best Practice & Research Clinical Obstetrics & Gynaecology.
The review highlights ongoing challenges, like deciding the best time to test for FNAIT, which antibody levels need treatment and how to avoid over-treatment.
The authors stated that starting screening programs—carefully tested through research—is the best way to close current knowledge gaps and reduce serious complications.
Read more about FNAIT testing and diagnosis
FNAIT happens when a pregnant woman’s immune system mistakenly attacks her baby’s platelets—the blood cells that help stop bleeding. This usually happens because the baby has inherited a platelet protein from the father that the mother’s body perceives as foreign. In response, her immune system makes antibodies (proteins that normally fight infections), which can cross the placenta and destroy the baby’s platelets. This can lead to very low platelet counts and, in serious cases, bleeding in the baby’s brain, called intracranial hemorrhage.
The condition affects about one in every 1,000 to 2,000 pregnancies, and approximately 60% of cases happen in the first pregnancy, before doctors know there is a risk. Right now, there is no routine test for FNAIT, so most cases are found only after a baby is born with visible bleeding symptoms.
Studies from countries like Norway and the Netherlands show that testing pregnant women for HPA-1a and related antibodies can identify pregnancies at risk of FNAIT, giving doctors time to start treatment with intravenous immune globulin (IVIG) to protect the baby and lower the chance of bleeding problems.
“Timely intervention can prevent severe complications associated with FNAIT, avoiding disabilities that impact both the child’s and the family’s quality of life,” the review authors said. “Moreover, preventing fetal and neonatal intracranial hemorrhage significantly reduces lifelong healthcare expenses, benefiting society.”
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