A review article recently published in the European Journal of Haematology details the recommendations for a variety of hematologic pregnancy complications including fetal and neonatal alloimmune thrombocytopenia (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.).
“Recognizing and treating these complications can be challenging due to the limited evidence available to guide clinical consultants,” the authors wrote. This is in part due to the fact that pregnant individuals are commonly excluded from clinical trials to avoid potential harm to the fetus.
In their study, the investigators identified several hematologic complications associated with pregnancy, providing an overview of existing knowledge and emphasizing the remaining gaps in understanding. Among these are multiple subtypes of thrombocytopeniaThrombocytopenia A platelet count that is lower than normal. such as FNAIT.
Thrombocytopenia is defined as a platelet countPlatelet count A measure of how many platelets are in the blood. FNAIT is characterized by severely reduced counts in a fetus or newborn. below 1500 platelets per liter. In FNAIT, the fetus inherits the father’s platelet antigens and the mother’s immune system recognizes the protein as foreign, producing antibodies against them. These antibodies will then attack the fetus’ platelets, causing thrombocytopenia.
Read more about FNAIT causes and risk factors
FNAIT does not have a unique screening test. However, a complete blood count, platelet immunological testing, and cranial ultrasound can aid in diagnosis. Additionally, if an individual experienced FNAIT in a previous pregnancy, maternal 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., sometimes in combination with corticosteroids, may be prescribed.
There are many potential complications associated with FNAIT, including poor growth, bleeding, and intracranial hemorrhageBrain bleed Bleeding inside the fetal brain, also known as an intracranial hemorrhage. In FNAIT, it's often caused by severe thrombocytopenia and can lead to long-term disability or death. .
Intrauterine platelet transfusions can be used to prevent thrombocytopenia. However, current guidelines recommend against the practice due to the risk of severe complications including hemorrhageFetal hemorrhage Any bleeding that occurs before birth. In FNAIT, this usually results from extremely low platelet counts. and death.
In many cases of FNAIT, thrombocytopenia will be resolved within two to six weeks following delivery. However, the duration may vary depending on the severity of the disease.
The study also details guidelines for a wide variety of other hematologic complications, including anemia, bleeding disorders, and venous thromboembolism.
“Early recognition and intervention are essential to mitigate potential complications,” the authors wrote. “However, the absence of carefully conducted prospective studies complicates decision-making for consultants and future research is needed in many of the areas outlined in this review.”
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