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NAIT for the Physician

What is Neonatal Alloimmune Thrombocytopenia: NAIT?

 

NAIT is best described as the Platelet Equivalent of Rh disease. The mother lacks a platelet antigen possessed by father; she is exposed to it by fetal platelets. In turn the mother makes a (strong) IgG antibody against the fetal platelet antigen: anti-PIA1. The IgG anti-platelet antibody crosses the placenta, destroys fetal platelets, and results in an often early, severe
thrombocytopenia often leading to an ICH in the fetus.

 

Typical NAIT:
NAIT is characterized by:

  • Severe thrombocytopenia (< 50 or even • Otherwise well, term child with good apgar scores, normal spontaneous vaginal delivery, and no distress
  • No clinical reason for the thrombocytopenia
  • Positive Laboratory work/up of the suspected fetus/neonate (this includes testing of
  • parents in reference laboratory).

 

Treatment of NAIT:
The treatment of NAIT is IVIG given weekly or Bi-weekly beginning at 12 or 20 weeks gestation depending on the history of the previous sibling given with or without prednisone daily. We believe that the IVIG and prednisone cross the placenta and work to block the antibody
production, therefore preventing a low platelet count in the fetus.

 

IVIG is administered as follows:

  • First dose of IVIG needs to be given in a controlled setting to monitor for allergic reaction for example, IVIG can be given in an infusion center at a hospital.
  • Subsequent doses can be given in at home, administered by a qualified Registered Nurse with experience in treating pregnant women and trained in the administration of IVIG who will spend the duration of the IVIG treatment with the patient.

 

 

NAIT for the Patient

Neonatal Alloimmune Thrombocytopenia

 

Fetal and Neonatal Alloimmune Thrombocytopenia, NAIT is a result of parental incompatibility of a platelet-specific antigen. NAIT can be thought of as the Platelet Equivalent of Rh disease. The mother lacks platelet antigen possessed by father; she is exposed to it by fetal platelets. Mother makes a (strong) IgG antibody against the fetal platelet antigen, the anti-platelet antibody crosses the placenta, destroys fetal platelets, and results in an often early, severe thrombocytopenia (low platelet count).

 

NAIT affects approximately 1 in 1,000 live births. This disorder is the most common cause of severe thrombocytopenia in fetuses and term neonates and the most frequent cause of
intracranial hemorrhage (ICH-bleeding in the brain) in term newborns. The only established indicator of an increased risk of intracranial bleeding in utero is a history of an antenatal ICH (a bleed occurring or present before birth, during pregnancy) in a previous affected sibling. The disease tends to worsen in subsequent pregnancies and affected fetuses may suffer an ICH even if their older siblings did not.

 

The goal of treating NAIT during pregnancy is to eliminate intracranial bleeding. Maternally administered intravenous immunoglobulin (IVIG) has been the most successful therapy explored to date in restoring adequate fetal platelet counts and preventing ICH.

 

BiologicTx Specialty™ Services

 

At BiologicTx Specialty™, our team of Registered Professional Nurses specializing in infusions, are experienced in the administration of IVIg and related medications. Each patient, prior to the first home infusion, will be assigned an infusion nurse. This same nurse will be responsible for administering all in home IVIg treatments through BiologicTx Specialty™. Our infusion nurse will review the patient’s medical history to confirm the safety of the medication to be administered prior to initiating treatment and ensure the comfort of the patient. The infusion nurse will administer the medication and remain with the patient throughout treatment to ensure the safety of the patient and to confirm that all medication was given, as directed. At the conclusion of each treatment, our infusion nurse will provide the patient’s physician with a full treatment report including any adverse events related to treatment.