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The right transfusion, always, everywhere.
Managing patients with fetal/neonatal alloimmune thrombocytopenia
Why did ICTMG develop a guideline for FNAIT?
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) may result in severe bleeding, particularly fetal and neonatal intracranial haemorrhage. As a result, FNAIT requires prompt identification and treatment; subsequent pregnancies need close surveillance and management.
ICTMG's recommendations provide guidance on the antenatal and postnatal management of FNAIT for haematologists, maternal fetal medicine specialists, immunologists, transfusion medicine specialists, paediatricians and neonatologists.
How to access the ICTMG publications
ICTMG developed three systematic reviews and a guideline on the management of fetal and neonatal alloimmune thrombocytopenia.
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Dian Winkelhorst, Michael F. Murphy, Andreas Greinacher, Nadine Shehata, Taman Bakchoul, Edwin Massey, Jillian Baker, Lani Lieberman, Susano Tanael, Heather Hume, Donald M. Arnold, Shoma Baidya, Gerald Bertrand, James Bussel, Mette Kjaer, Cécile Kaplan, Jens Kjeldsen-Kragh, Dick Oepkes, Greg Ryan. Antenatal management in fetal and neonatal alloimmune thrombocytopenia: a systematic review. Blood (2017) 129 (11): 1538–1547.
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Mette Kjær Gerald Bertrand Tamam Bakchoul Edwin Massey Jillian M. Baker Lani Lieberman Susano Tanael Andreas Greinacher Michael F. Murphy Donald M. Arnold Shoma Baidya James Bussel Heather Hume Cécile Kaplan Dick Oepkes Greg Ryan Helen Savoia Nadine Shehata Jens Kjeldsen‐Kragh on behalf of International Collaboration for Transfusion Medicine Guidelines. Maternal HPA ‐1a antibody level and its role in predicting the severity of Fetal/Neonatal Alloimmune Thrombocytopenia: a systematic review. Vox Sanguinis (2019) 114 (1): 79-94.
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Jillian M. Baker, Nadine Shehata, James Bussel, Michael F. Murphy, Andreas Greinacher, Tamam Bakchoul, Edwin Massey, Lani Lieberman, Denise Landry, Susano Tanael, Donald M. Arnold, Shoma Baidya, Gerald Bertrand, Mette Kjaer, Cécile Kaplan, Jens Kjeldsen-Kragh, Dick Oepkes, Helen Savoia, Greg Ryan, Heather Hume & on behalf of the International Collaboration for Transfusion Medicine Guidelines (ICTMG). Postnatal intervention for the treatment of FNAIT: a systematic review. Journal of Perinatology (2019) 39: 1329–1339.
ICTMG's guideline on the management of patients with fetal and neonatal alloimmune thrombocytopenia was published in British Journal of Haematology in 2019:
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Lani Lieberman Andreas Greinacher Michael F. Murphy James Bussel Tamam Bakchoul Stacy Corke Mette Kjaer Jens Kjeldsen‐Kragh Gerald Bertrand Dick Oepkes Jillian M. Baker Heather Hume Edwin Massey Cécile Kaplan Donald M. Arnold Shoma Baidya Greg Ryan Helen Savoia Denise Landry Nadine Shehata for the International Collaboration for Transfusion Medicine Guidelines (ICTMG). Fetal and neonatal alloimmune thrombocytopenia: recommendations for evidence‐based practice, an international approach. British Journal of Haematology (2019) 185 (3):549-562.
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To download a pdf of the article click here.
ICTMG conducted a systematic review and meta-analysis to determine the association between maternal HLA-DRB3*01:01 and: (1) HPA-1a-alloimmunization and (2) neonatal outcome in children born of HPA-1a-immunized women. This systematic review was published open-access in Blood Advances in August 2020:
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Jens Kjeldsen-Kragh, Dean A. Fergusson, Mette Kjaer, Lani Lieberman, Andreas Greinacher, Michael F. Murphy, James Bussel, Tamam Bakchoul, Stacy Corke, Gérald Bertrand, Dick Oepkes, Jillian M. Baker, Heather Hume, Edwin Massey, Cecile Kaplan, Donald M. Arnold, Shoma Baidya, Greg Ryan, Helen F. Savoia, Denise Landry, Nadine Shehata. Fetal/neonatal alloimmune thrombocytopenia: a systematic review of impact of HLA-DRB3*01:01 on fetal/neonatal outcome. Blood Adv (2020) 4 (14): 3368–3377.
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To download a pdf of the article click here.
Additional resources for physicians
Podcast for physicians - FNAIT guideline
Listen to Dr. Richard Wells, hematologist, in conversation with Dr. Donnie Arnold, hematologist, and Dr. Dick Oepkes, obstetrician and maternal fetal medicine specialist.
In this 2-Part podcast, they discuss management of FNAIT and is intended to provide guidance on the antenatal and postnatal testing and screening for FNAIT. This podcast complements the two systematic reviews published in Blood and Vox Sanguinis (see publications above).
Please use or adapt our presentation for education or training purposes. Download the slide deck here.
Print out the decision-making algorithm summarizing ICTMG’s recommendations for managing pregnant women with previous FNAIT during the antenatal period. It can be used by haematologists, maternal fetal medicine specialists, immunologists, transfusion medicine specialists, paediatricians and neonatologists.
Print out the decision-making algorithm summarizing ICTMG’s for managing neonate with suspected FNAIT. It can be used by haematologists, maternal fetal medicine specialists, immunologists, transfusion medicine specialists, paediatricians and neonatologists.
American Society of Hematology case study
Review a case study on the American Society of Hematology (ASH) website that cites ICTMG’s 2019 publication on management of patients with FNAIT: Prenatal management of 21 year-old woman to reduce risk of severe thrombocytopenia and intracranial hemorrhage.
Additional resources for patients
Podcast for patients - FNAIT: Questions and answers for patients
Listen to a conversation between Drs. Lani Lieberman, Jens Kjeldsen-Kragh, and Michael F. Murphy, physicians with FNAIT expertise, and Sarah Bloom and Fazeela Khan, patients affected by FNAIT.
They answer questions such as “what is FNAIT?” and discuss treatments in pregnancies affected by FNAIT. It complements the patient pamphlets published by ICTMG on this website.
Patient pamphlets - FNAIT: Patient information
English
French
Italian
German
Japanese
Portuguese
Spanish
International reach
The ICTMG guideline on managing patients with fetal/neonatal alloimmune thrombocytopenia provides guidance on the antenatal and postnatal management of FNAIT. Check out how the guideline is being used or adapted in different countries.
American Society of Hematology
In July 2019, the American Society of Hematology (ASH) affirmed that ICTMG's guidelines have value for hematologists. Read the ASH statement here: https://www.hematology.org/Clinicians/Guidelines-Quality/3127.aspx
National Advisory Committee on Blood and Blood Products (Canada)
In January 2022, the National Advisory Committee (NAC) on Blood Products (Canada) endorsed the ICTMG Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) guidelines. Read the NAC statement here.
