title: A review of pathophysiology and current treatment for neonatal alloimmune thrombocytopenia (NAIT) and introducing the Australian NAIT registry.
abstract: Fetomaternal or neonatal alloimmune thrombocytopenia (NAIT) is a rare but serious condition associated with significant fetal and neonatal morbidity and mortality. The most useful predictor of severe disease is a history of a sibling with an antenatal intracranial haemorrhage. However, NAIT can occur during the first pregnancy and may not be diagnosed until the neonatal period. Antenatal treatment options include maternal intravenous immunoglobulin (IVIG) and corticosteroid treatment, fetal blood sampling (FBS) and intrauterine platelet transfusion (IUT) and early delivery. FBS (with or without IUT) can be used to direct and monitor response to therapy, and to inform mode and timing of delivery. However, this procedure is associated with significant risks, including fetal death, and is generally now reserved for high-risk pregnancies. This review highlights the current understanding of the epidemiology and pathophysiology of NAIT and summarises current approaches to investigation and management. It also introduces the newly established Australian NAIT registry. Owing to the relative rarity of NAIT, accruing sufficient patient numbers for studies and clinical trials at an institutional level is difficult. This national registry will provide an opportunity to collect valuable information and inform future research on this condition.
authors.affiliation: Transfusion Medicine Services, Australian Red Cross Blood Service, South Melbourne, Victoria 3205, Australia. zmcquilten@arcbs.redcross.org.au
authors.forename: Zoe K
authors.initials: ZK
authors.lastname: McQuilten
authors.forename: Erica M
authors.initials: EM
authors.lastname: Wood
authors.forename: Helen
authors.initials: H
authors.lastname: Savoia
authors.forename: Stephen
authors.initials: S
authors.lastname: Cole
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D016824:Antigens, Human Platelet / Q000235:genetics / Q000276:immunology; D001315:Australia; D001800:Blood Specimen Collection / Q000009:adverse effects; D001805:Blood Transfusion, Intrauterine; D005260:Female; D005312:Fetal Blood; D046689:Fetal Mortality; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007226:Infant Mortality; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000276:immunology / Q000628:therapy; D017713:Platelet Transfusion; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D012042:Registries; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D016824:Antigens, Human Platelet; D016756:Immunoglobulins, Intravenous