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Fetal and neonatal alloimmune thrombocytopenia


- Chair and Department of Anaesthesiology and Intensive Care, Poznan University of Medical Sciences, Poznan, Poland
- Chair and Department of Neonatology, Poznan University of Medical Sciences, Poland
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Abstract
Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is defined as a platelet count <150,000/μL due to reaction between maternal antibodies and antigens located on thrombocytes of the fetus/neonate. Such a kind of pathology occurs when a mother does not possess specific human platelet antigens (HPA), which are inherited as an infant from the father. HPA-1a is an antigen that most often causes FNAIT in the Caucasian race. Frequency of FNAIT has been estimated as 1:350–1:5000. In the pathogenesis of FNAIT, the mother organism is immunized and produces alloantibodies from which IgG pass through the placenta, enter fetal circulatory system and cause platelet destruction. It usually takes place at the end of the second trimester. FNAIT can occur in the first pregnancy; nonetheless, it is more probable and connected with higher severity in subsequent gestations. It is caused by the fact that immunization usually takes place during the first labour, which enables production of alloantibodies in the next pregnancies. Nevertheless, other ways of immunization are also possible, which ensures that FNAIT cases in the first pregnancy are not casuistic and occur more often than RhD hemolytic disease of the newborn. Thrombocytopenia leads to coagulation disorders, and consequently to bleedings. FNAIT can be manifested not only by some petechiae on the skin, but also by severe hemorrhages in the body cavities and gastrointestinal tract or by intracranial hemorrhages (ICH). In case the symptoms are presented by an infant, platelet transfusions are performed, and IVIG (intravenous immunoglobulin) therapy is administered.
Abstract
Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is defined as a platelet count <150,000/μL due to reaction between maternal antibodies and antigens located on thrombocytes of the fetus/neonate. Such a kind of pathology occurs when a mother does not possess specific human platelet antigens (HPA), which are inherited as an infant from the father. HPA-1a is an antigen that most often causes FNAIT in the Caucasian race. Frequency of FNAIT has been estimated as 1:350–1:5000. In the pathogenesis of FNAIT, the mother organism is immunized and produces alloantibodies from which IgG pass through the placenta, enter fetal circulatory system and cause platelet destruction. It usually takes place at the end of the second trimester. FNAIT can occur in the first pregnancy; nonetheless, it is more probable and connected with higher severity in subsequent gestations. It is caused by the fact that immunization usually takes place during the first labour, which enables production of alloantibodies in the next pregnancies. Nevertheless, other ways of immunization are also possible, which ensures that FNAIT cases in the first pregnancy are not casuistic and occur more often than RhD hemolytic disease of the newborn. Thrombocytopenia leads to coagulation disorders, and consequently to bleedings. FNAIT can be manifested not only by some petechiae on the skin, but also by severe hemorrhages in the body cavities and gastrointestinal tract or by intracranial hemorrhages (ICH). In case the symptoms are presented by an infant, platelet transfusions are performed, and IVIG (intravenous immunoglobulin) therapy is administered.
Keywords
Newborn; Thrombocytopenia; Alloimmunization


Title
Fetal and neonatal alloimmune thrombocytopenia
Journal
Issue
Pages
119-124
Published online
2017-04-01
Page views
113
Article views/downloads
1217
DOI
10.1016/j.achaem.2017.01.004
Bibliographic record
Acta Haematol Pol 2017;48(2):119-124.
Keywords
Newborn
Thrombocytopenia
Alloimmunization
Authors
Irmina Nowak
Weronika Kubiak-Prałat
Marcin Minta
Marta Szymankiewicz
Janusz Gadzinowski
Dawid Szpecht