A successful outcome has been r eported in a patient in India with a history of fetal and neonatal alloimmune thrombocytopenia (FNAIT), according to findings from a case report published recently in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology.
A 28-year-old woman presented to the Institute of Obstetrics and Gynecology (IOG), located in Egmore, Chennai, Tamil Nadu, India, at 18 weeks’ gestational age (GA). She had a history of FNAIT in her first pregnancy.
To highlight the rarity of FNAIT, this was recognized to be the first recorded case of the disease at IOG—a 180-year-old institution. It is estimated that FNAIT occurs in one of 1000 to 2000 live births.
This was the woman’s second pregnancy, with her first pregnancy ending in the death of the newborn. At this time, the physicians recognized that the baby’s death was associated with FNAIT.
Both parents were referred for genetic counseling. Blood samples obtained from the mother and the father for human platelet antigen (HPA) genotyping confirmed the FNAIT diagnosis.
Read more about the FNAIT care team
The treatment method
Per protocol, orally administered prednisone 30 mg/kg of body weight was initiated in the mother at 18 weeks’ GA and continued until delivery.
According to a severity-based approach recommended by the American College of Obstetricians and Gynecologists, the mother was started on intravenous immunoglobulin (IVIg) at 20 weeks’ GA, at a rate of 1 g/kg per week. Based on availability and affordability restrictions, she instead received IVIg 0.5 g/kg per week. Ultimately, she received a total of 11 doses of IVIg during the course of her pregnancy.
At 22 weeks’ GA, the mother developed gestational diabetes, which resulted in the initiation of insulin therapy.
Every 4 weeks, ultrasonography of the fetal brain was performed, to rule out the presence of any intracranial hemorrhages.
Baby born without thrombocytopenia
At 34 weeks’, four days’ GA, the pregnant woman presented to IOG with complaints of drainage and abdominal pain.
She underwent an emergency lower segment cesarean section and delivered a live preterm girl who weighed 2.470 kg. The newborn, who cried immediately after birth, was taken to the neonatal intensive care unit for preterm care. There was no thrombocytopenia reported in the infant.
The mother and her baby were discharged from the hospital on postoperative day 10.
“This [case] is certainly a promise of the [improved] management and outcome[s] of [this] condition in the many years to come,” the authors concluded.
