Table 1.

FNAIT current treatment methods

	Clinical situation	Treatment strategy	References
1	FNAIT accidentally discovered in a neonate after delivery: postnatal treatment Subsequent pregnancy must be treated according to strategy 2b or 2c	Depends on the platelet count and clinical symptoms In case of very low platelet count with or without ICH, the newborn should immediately receive a platelet transfusion:	Bussel et al. (2010), Kanhai et al. (2007), Murphy and Bussel (2007), van den Akker et al. (2007)
		Compatible platelets from blood donor or maternal platelets (remove plasma which contain alloantibodies)
		If antigen negative platelets are not available, the newborn should be transfused with random buffy coat platelets
		IVIG may also be applied
2	FNAIT suspected based on patient’s history: the woman has previously given birth to an affected child
	Prenatal treatment of current and subsequent pregnancy:
2a		Invasive strategy: FBS and intrauterine transfusion (IUT) of mother platelets once a week (not recommended in many countries)	Overton et al. (2002), van Kamp et al. (2005)
2b		Combined strategy:	Bussel et al. (2010)
		Treatment of the mother with IVIG with or without steroids
		Diagnostic FBS to evaluate fetal platelet count, combined with preventive IUT with maternal platelets (not recommended in many countries)
		The mode of delivery depends on fetal platelet count
2c		Non-invasive strategy:	Kamphuis and Oepkes (2011)
		Treatment of the mother with IVIG with or without steroids, without diagnostic FBS
		In some countries this line of treatment is followed by spontaneous delivery or by cesarean section a few weeks before term with compatible platelets available for the baby after delivery
3	FNAIT suspected based on detection of anti-HPA-1a antibodies within the screening program: women in first pregnancy (primigravidae), with no obstetric history
	Prenatal treatment of current and subsequent pregnancy:
3a		Conservative management:	Kjeldsen-Kragh et al. (2007)
		No treatment during pregnancy
		Cesarean section a few weeks prior to term with compatible platelets to be transfused immediately in severely thrombocytopenic neonates
3b		Combined strategy:	PREVFNAIT study
		Diagnostic FBS with preventive intrauterine transfusion of maternal platelets to evaluate fetal platelet count
		Treating mothers of thrombocytopaenic fetuses with IVIG with or without steroids
		The mode of delivery depends on fetal platelet count