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Disorders of Thrombosis and Hemostasis in Pregnancy pp 171–184Cite as

Thrombocytopenia in Pregnancy: Fetal and Neonatal Alloimmune Thrombocytopenia

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Abstract

Fetal/neonatal alloimmune thrombocytopenia (FNAIT) results from the formation of antibodies by the mother which are directed against a fetal platelet alloantigen inherited from the father. The maternal alloantibodies cross the placenta and destroy the baby’s platelets, and the resulting fetal thrombocytopenia may cause bleeding, particularly into the brain, before or shortly after birth. Approximately 10–20 % of affected fetuses have intracranial hemorrhages, one quarter to one half of which occur in utero. There are considerable controversies regarding the optimal management of FNAIT-affected pregnancies. There is no clear approach to the antenatal management of first affected pregnancies, and several questions remain in the approaches to the management of second and subsequent affected pregnancies. Currently, antenatal management of FNAIT consists of weekly maternal intravenous immunoglobulin (IVIg) infusions, with or without oral steroid therapy – the optimal steroid dosages and protocols remain to be stratified. Some centers continue to offer serial intrauterine platelet transfusions as first-line therapy, but the multiple cordocenteses that would be required to administer the platelets carry substantial risk of fetal demise. Possibilities for antenatal screening of first pregnancies are being developed. Postnatal screening does not prevent neonatal morbidity and mortality.

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Abbreviations

FBS:

Fetal blood sampling

FNAIT:

Fetal neonatal alloimmune thrombocytopenia

HPA:

Human platelet antigen

ICH:

Intracranial hemorrhage

ITP:

Idiopathic thrombocytopenia

IUPT:

Intrauterine platelet transfusion

IVIg:

Intravenous immunoglobulin

NIPD:

Noninvasive prenatal diagnosis

NOICH:

Study: no intracranial hemorrhage study

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Author information

Authors and Affiliations

  1. Consultant in Obstetrics and Gynaecology, Queen Elizabeth Hospital, South London Healthcare Trust, Stadium Road, Woolwich, SE18 4QH, London

    Sukrutha Veerareddy MRCOG

  2. Consultant in Fetal Medicine, University College London Hospitals, 250 Euston Road, London, NW1 2PG, UK

    Pranav Pandya MD, FRCOG

Authors
  1. Sukrutha Veerareddy MRCOG
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  2. Pranav Pandya MD, FRCOG
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Corresponding author

Correspondence to Pranav Pandya MD, FRCOG .

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Editors and Affiliations

  1. Aberdare Gardens 36, London, NW6 3QA, United Kingdom

    Hannah Cohen

  2. Dept. Obstetrics & Gynaecology, University College Hospital, Chenies Mews 86-96, London, WC1E 6HX, United Kingdom

    Patrick O'Brien

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© 2012 Springer-Verlag London

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Veerareddy, S., Pandya, P. (2012). Thrombocytopenia in Pregnancy: Fetal and Neonatal Alloimmune Thrombocytopenia. In: Cohen, H., O'Brien, P. (eds) Disorders of Thrombosis and Hemostasis in Pregnancy. Springer, London. https://doi.org/10.1007/978-1-4471-4411-3_12

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  • DOI: https://doi.org/10.1007/978-1-4471-4411-3_12

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