ABSTRACT
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the most common cause of severe neonatal thrombocytopenia and intracranial bleeding in term newborns. Intracranial hemorrhage (ICH) commonly results in death or severe, lasting neurologic disability. The timing of ICH is also important for management of the next affected pregnancy in cases of FNAIT. This manuscript reviews the advantages and disadvantages of the different radiologic methodologies to identify and characterize ICH. It discusses the limits of ultrasound and the advantages of magnetic resonance imaging allowing avoidance of the radiation associated with computed tomography (CT) scans.
Subject(s)
Fetal Diseases/diagnostic imaging , Intracranial Hemorrhages/diagnostic imaging , Thrombocytopenia, Neonatal Alloimmune/diagnostic imaging , Thrombocytopenia, Neonatal Alloimmune/therapy , Female , Humans , Infant, Newborn , Magnetic Resonance Imaging , Pregnancy , Tomography, X-Ray ComputedABSTRACT
The scientific goals related to the grant include 1) estimation of FNAIT prevalence in Poland and 2) search for biomarkers to predict the risk of the antibody production and severity of fetal thrombocytopenia. Fetal/Neonatal Alloimmune Thrombocytopenia (FNAIT) is caused by destruction of fetal blood platelets due to maternal antibodies. This condition, which most commonly results from incompatibility between the mother and the fetus for the Human Platelet Antigen-1a (HPA-1a), may lead to intracranial hemorrhage, damage of the central nervous system (CNS) and even death of the fetus or the newborn. It can be the cause of strokes in term newborns. FNAIT is usually attributed to the presence of anti-HPA-1a antibodies. Its incidence rate is estimated at approximately 1/1000-2000 live births. In the absence of a screening program, it is usually diagnosed after birth of a child with symptoms of thrombocytopenia or CNS hemorrhage. Monitoring of antibody production and thrombocytopenia treatment to effectively minimize the risk of stroke are therefore launched only at the next pregnancy. Testing indications are broader to include fetal ultrasound for symptoms of stroke to the CNS, ventricular enlargement or hydrocephalus, and obstetric failure. Diagnostic process is also recommended prior to the planned cordocentesis, in vitro fertilization and in sisters of mothers with children with FNAIT history. HPA-1a testing remains the best method for diagnosing pregnancies at risk. The detection frequency for FNAIT in Poland remains low. Therefore, the Institute of Hematology and Transfusion Medicine (IHTM) will have performed such HPA-1a antigen testing in 30 000 Polish women within the framework of the PREVFNAIT program by March 2016. HPA-1a negative women (2% of the population) are a risk group for production of anti- HPA-1a antibodies responsible for FNAIT therefore all of them will be monitored for the presence and activity of anti-HPA-1a antibodies. Such testing will be performed free of charge for the women.
Subject(s)
Fetal Diseases/diagnosis , Fetal Diseases/prevention & control , Maternal Health Services/organization & administration , Primary Prevention/organization & administration , Thrombocytopenia, Neonatal Alloimmune/diagnosis , Thrombocytopenia, Neonatal Alloimmune/prevention & control , Female , Fetal Diseases/diagnostic imaging , Humans , Incidence , National Health Programs/organization & administration , Poland/epidemiology , Pregnancy , Prenatal Care/organization & administration , Prevalence , Risk Assessment/organization & administration , Thrombocytopenia, Neonatal Alloimmune/diagnostic imaging , Thrombocytopenia, Neonatal Alloimmune/epidemiology , UltrasonographyABSTRACT
Neonatal alloimmune thrombocytopenia is a serious disease, in which the mother produces antibodies against fetal platelet antigens inherited from the father; it is still an underdiagnosed disease. This disease is considered the platelet counterpart of the RhD hemolytic disease of the fetus and newborn, yet in neonatal alloimmune thrombocytopenia the first child is affected with fetal and/or neonatal thrombocytopenia. There is a significant risk of intracranial hemorrhage and severe neurological impairment, with a tendency for earlier and more severe thrombocytopenia in subsequent pregnancies. This article reports a case of neonatal alloimmune thrombocytopenia in the second pregnancy affected and discusses diagnosis, management and the clinical importance of this disease.
Subject(s)
Pregnancy, High-Risk , Thrombocytopenia, Neonatal Alloimmune/therapy , Adult , Antigens, Human Platelet/genetics , Female , Humans , Immunoglobulins, Intravenous/administration & dosage , Infant, Newborn , Intracranial Hemorrhages/diagnostic imaging , Intracranial Hemorrhages/prevention & control , Male , Platelet Count , Pregnancy , Risk Assessment , Thrombocytopenia, Neonatal Alloimmune/diagnostic imaging , Treatment Outcome , Ultrasonography, PrenatalABSTRACT
Alloimmune thrombocytopenia (AIT) is an important cause of intrauterine hemorrhagic lesions that result from platelet-antigen incompatibility between mother and foetus. Foetal platelets are destroyed by cross-reactive maternal antibodies that cross the placenta. The most serious complication of AIT is foetal intracranial bleeding that may eventually result in intrauterine death or severe neurological impairments.