Neonatal alloimmune thrombocytopenia: Parental evaluation and pregnancy management
- Michael J Paidas, MD
Michael J Paidas, MD
- Professor, Department of Obstetrics, Gynecology and Reproductive Sciences
- Yale University School of Medicine
Neonatal alloimmune thrombocytopenia (NAIT) is a disorder in which fetal platelets contain an antigen inherited from the father that the mother lacks, most commonly human platelet antigen (HPA)-1a incompatibility. The mother then develops antibodies against this paternal antigen and these antibodies cross the placenta and bind to the fetal platelets. Clearance of the antibody-coated platelets results in fetal/neonatal thrombocytopenia; platelet function remains relatively normal. In contrast to Rh(D) alloimmunization, NAIT often affects a first pregnancy .
Two plausible mechanisms have been proposed to explain the occurrence of maternal alloimmunization in NAIT. One mechanism involves maternal exposure to HPA on fetal platelets due to fetomaternal bleeding related to obstetrical complications, trauma, or delivery. The other mechanism is maternal exposure to integrin beta-3 on placental syncytiotrophoblast cells during pregnancy .
This topic will provide a brief overview of NAIT and discuss parental evaluation and management of affected pregnancies. Postnatal issues are reviewed separately. (See "Causes of neonatal thrombocytopenia", section on 'Fetal and neonatal alloimmune thrombocytopenia'.)
All of the following criteria are necessary to diagnosis neonatal alloimmune thrombocytopenia:
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- PARENTAL TESTING
- Pregnant or postpartum women with pregnancy history suggestive of NAIT
- Pregnant women with a sister whose child had or may have had NAIT
- Pregnant women with no personal or family history of NAIT
- SEVERITY-BASED APPROACH FOR MANAGING PREGNANCIES AT RISK OF NAIT
- Fetal platelet typing
- Standard risk pregnancies
- - Antepartum management
- - Delivery
- High-risk pregnancies
- - Antepartum management
- - Delivery
- Extremely high-risk pregnancies
- - Antepartum management
- - Delivery
- Cordocentesis and platelet transfusion
- Monitoring for intracranial hemorrhage
- Medication risks
- MANAGEMENT OF OTHER CLINICAL SCENARIOS
- Personal history of fetal intracranial hemorrhage/neonatal thrombocytopenia and HPA incompatibility but no antibodies
- Personal history of fetal intracranial hemorrhage/neonatal thrombocytopenia, but no HPA incompatibility and no antibodies
- No personal history of fetal intracranial hemorrhage or neonatal thrombocytopenia, but HPA incompatibility
- REPRODUCTIVE OPTIONS
- SUMMARY AND RECOMMENDATIONS