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Educational session: fetal and neonatal alloimmune thrombocytopenia

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal alloimmunization against fetal platelet antigens inherited from the father and different from those present in the mother, and usually presents as a severe isolated thrombocytopenia in otherwise healthy newborns [1]. The incidence has been estimated at 1/800 to 1/1000 live births [2,3]. Fetal platelet destruction is mediated following transplacental passage of specific antiplatelet maternal alloantibodies. The syndrome may be regarded as the platelet counterpart of haemolytic disease of the fetus and newborn (HDFN), but, in contrast to HDFN, FNAIT frequently occurs during first pregnancies. The most feared complication of FNAIT in case of severe thrombocytopenia is the occurrence of intracranial haemorrhage (ICH), leading to death or neurological sequelae. As most cases are first diagnosed at birth, the term neonatal alloimmune thrombocytopenia (NAIT) has been widely used. Since the first description of these conditions in the 1950s [4], significant progress has been made in laboratory diagnosis and the management of this condition.