Learn The BasicsFetal and neonatal alloimmune thrombocytopenia is a rare blood disorder affecting fetuses and newborn babies. It is caused by a pregnant woman’s body making antibodies against proteins found on the surface of her baby’s platelets, which do not match her own, thereby causing their destruction. Platelets are blood components that are essential for bleeding and if their number is too low, severe bleeding may occur.
FNAIT is not routinely tested for during pregnancy, and a diagnosis is usually only reached if the baby is experiencing signs and symptoms of low platelet counts at birth ,such as bleeding, bruising, petechiae or purpura.
If a woman has had a previous baby with FNAIT, she should be cared for by a doctor wo specializes in fetal-maternal medicine during her pregnancy and labor.
A multidisciplinary team of specialists including an obstetrician, a fetal medicine specialist and a hematologist with expertise in FNAIT will likely be part of her care team.
Obstetricians
Obstetricians are often the first specialists any pregnant woman sees. They are trained to provide care during the pregnancy and birth and following delivery.
Fetal medicine specialists
Fetal medicine specialists are obstetricians who are trained in assessing and managing high-risk pregnancies.
In pregnancies at high risk of FNAIT, a fetal medicine specialist should closely monitor the pregnancy for any complications.
The fetal medicine specialist should also manage planned deliveries and in case of high risk of FNAIT, may plan an earlier than normal delivery to reduce the risk of complications due to FNAIT.
The International Collaboration for Transfusion Medicine Guidelines (ICTMG) suggests that invasive procedures such as the use of forceps or vacuum should be avoided during the delivery of a baby at high risk of FNAIT.
Hematologists
Hematologists specialize in the care of patients with blood disorders. They play a key role in the assessment of babies affected by FNAIT and the treatment course needed such as a platelet transfusion.
Neonatologists
A neonatologist is a doctor specializing in the treatment of newborns. They will assess the newborn baby for any signs of bleeding due to low platelet counts and examine them for any other possible complications.
In case the baby has very low platelet counts and needs a platelet transfusion, the neonatologist will oversee the management of the disease.
Transfusion specialists
The transfusion specialist plays an important role in the care of babies affected by FNAIT.
The ICTMG suggests that if a baby with FNAIT requires a platelet transfusion, human platelet-antigen (HPA)-selected platelets should be used, if available. If they are not available, HPA unselected platelets may also be used. HPA is the protein that triggers the production of antibodies by the mother’s body.
The clinical geneticists
The clinical geneticist can offer information about the genetic cause of FNAIT.
The clinical geneticist can provide options for genetic testing for the baby’s parents or the mother’s sisters, who may also be at high risk of having a baby with FNAIT.
This is because pregnant women who develop antibodies against the platelet proteins of their baby have a rare platelet protein combination, which their sisters may share.
