Fetal and Neonatal Alloimmune Thrombocytopenia: A Concise Review

Abstract

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare disease resulting from the effect of maternal alloantibodies on fetal human platelet antigens HPAs which could lead to severe haemorrhage. An antibody from mother reacting against a defined platelet alloantigen has been identified as the aetiology of platelet destruction in an infant with this condition and several other platelet-specific antigens were implicated to be capable of initiating maternal immunization during pregnancy leading to fetal platelet destruction. However, in most cases of maternal sensitizations the exposure to fetal blood usually occur during delivery, resulting to thrombocytopenia in the newborn. Current management of fetal and neonatal alloimmune thrombocytopenia in the next pregnancy involves administration of intravenous immune globulin and steroids during antenatal for mothers with previous history or those at risk. Some advances has been suggested in the line of management and these include testing of cell-free fetal DNA obtained from maternal blood to determine the fetal human platelet antigen genotype, the creation of a prophylactic product; a platelet equivalent of Rhesus immune globulin and the development of neonatal Fc receptor inhibitors to replace the current medical therapy administered to pregnant women with an affected fetus. FNAIT is a devastating complication of pregnancy that can present with difficult diagnostic and treatment challenges. Hence, a need for surveillance.