Thrombocytopenia is one of the most common hematologic problems in the neonate. In alloimmune thrombocytopenia resulting from pregnancy, transfusion, or transplantation, there is a need for study of the similarities and differences in platelet autoantibodies and alloantibodies. Transfusion of a neonatal dose of abo, rhd compatible, and hpa1a and hpa5b negative platelets is treatment of choice, because these. A diagnosis of neonatal alloimmune thrombocytopenia should be considered for any. Treatment of more than 100 cases of fetal alloimmune thrombocytopenia has been described. Neonatal alloimmune thrombocytopenia is the most frequent cause of severe fetal and neonatal thrombocytopenia. Nait was first reported in the literature in 1953 and is estimated to occur in as many as 1 in 1200 live births.
Table 4 guidelines for platelet transfusion in the newborn. Neonatal alloimmune thrombocytopenia is the most common cause of immunemediated thrombocytopenia in the newborn period. Fmait is the leading cause of severe thrombocytopenia in the newborn, and should not be confused with autoimmune thrombocytopenia, in which both mother. How i manage neonatal thrombocytopenia wiley online library. The optimal treatment of a neonate with severe thrombocytopenia alloimmune thrombocytopenia, is an urgent correction of the platelet count. Identification and treatment needs to be immediate to avoid poor outcomes. Neonatal alloimmune thrombocytopenia maria teresa mella, keith a eddleman department of obstetrics and gynecology, division of maternal fetal medicine, mount sinai school of medicine, new york, ny, usa abstract. The disorder results from placental transfer of maternal alloantibodies directed against paternally inherited antigens carried on. Neonatal alloimmune thrombocytopenia nait should be suspected in newborns with incidentally detected thrombocytopenia or manifestations of a bleeding complication eg, ultrasound anomalies in utero that may suggest intracranial hemorrhage ich, petechiae, bruising, or purpura shortly after birth, hematomas that develop at sites of injection. Fetal and neonatal alloimmune thrombocytopenia ncbi. Neonatal thrombocytopenia is a common clinical problem. Definition thrombocytopenia is an abnormal drop in the number of blood cells involved in forming blood clots. The main causes of neonatal thrombocytopenia are now becoming clearer and. Our data show that antenatal treatment for fnait results in favourable perinatal outcome.
Neonatal alloimmune thrombocytopenia occurs in one in 1,0001,500 live births and is the most common cause of severe thrombocytopenia and intracranial hemorrhage in term infants. Pdf neonatal alloimmune thrombocytopenia international. A low platelet count increases the risk of bleeding in the fetus and newborn. The causes of thrombocytopenia in neonates are diverse and include immune, inherited, and acquired disorders. Neonatal thrombocytopenia american academy of pediatrics. Alloimmune thrombocytopenia definition of alloimmune. Pdf foetalneonatal alloimmune thrombocytopaenia nait results from.
Longterm effects of fetal and neonatal alloimmune thrombocytopenia and its antenatal treatment on the medical and developmental outcomes of affected children. Neonatal alloimmune thrombocytopenia nait arup consult. Fetal and neonatal alloimmune thrombocytopenia nait is a blood disorder that affects pregnant women and their babies. Follow up of children after antenatal treatment for alloimmune thrombocytopenia. Maternal hpa alloanti bodies of the igg class cross the placenta and bind to fetal platelets, shortening their survival. Thrombocytopenia presenting after 72 hours of age is usually secondary to sepsis or necrotising. The evaluation of the neonate with thrombocytopenia may be challenging. Although many cases are mild, nait is a significant cause of morbidity and mortality in newborns and is the most common cause of.
Fetus with severe thrombocytopenia is at the risk of acute bleeding. A thrombocytopenic fetus or newborn is at risk of intracranial hemorrhage that may result in lifelong. In some cases, the thrombocytopenia is also immunemediated. Further studies in fnait should address improvements in detection and management in order to reduce the mortality and morbidity of this condition. There is a significant risk of intracranial hemorrhage and severe neurological impairment, with a tendency for earlier and more severe thrombocytopenia in. It can cause severe complications and longterm disabilities. Neonatal alloimmune thrombocytopenia naitp, nait, natp or nat is a disease that affects babies in which the platelet count is decreased because the mothers immune system attacks her fetus or newborns platelets. Fetal and neonatal alloimmune thrombocytopenia fnait is caused by an immunological process in. Neonatal alloimmune thrombocytopenia, nait is caused by maternal antibodies raised against alloantigens carried on fetal platelets. Nait results in the destruction of platelets in the fetus or infant due to a mismatch between the mothers platelets and those of the baby. Fetomaternal alloimmune thrombocytopenia fmait is a relatively uncommon disease, but is the leading cause of severe thrombocytopenia in the newborn. Anti hpa1a, 5b e 15b are responsible for up to 95% cases. The optimal treatment of a neonate with severe thrombocytopenia treatment needs to be immediate to avoid poor outcomes. Severe thrombocytopenia in an otherwise well neonate even if no history.
If the bleeding occurs in the brain, there may be longterm effects. The normal amount of platelets is usually between 150,000. Thrombocytopenia with infection is usually caused by bone marrow suppression. Fetal and neonatal alloimmune thrombocytopenia genetic. Pdf foetal and neonatal alloimmune thrombocytopenia. Full text neonatal alloimmune thrombocytopenia ijctm. Fetal neonatal alloimmune thrombocytopenia fnait, also known as neonatal alloimmune thrombocytopenia nait or fetomaternal alloimmune thrombocytopenia fmait, is a rare condition which affects a babys platelets. Thrombocytopenia presenting in the first 72 hours of life is usually secondary to placental insufficiency and caused by reduced platelet production.
Neonatal alloimmune thrombocytopenia or nait or fetomaternal. Management of severe alloimmune thrombocytopenia in the. Description thrombocytopenia is a blood disease characterized by an abnormally low number of platelets in the bloodstream. Nait presents commonly in the newborn with unexpected bruising and purpura or can be the cause of severe intracranial haemorrhage. Although many cases are mild, nait is a significant cause of morbidity and mortality in newborns and is the most common cause of intracranial haemorrhage in fullterm infants.