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Pregnant women with IgG antibodies against paternally-inherited antigens on fetal platelets are at risk of having their pregnancy complicated with fetal and neonatal alloimmune thrombocytopenia (FNAIT). IgG antibodies can traverse the placenta and cause fetal thrombocytopenia and severe bleeding. Thus, FNAIT can be considered as the platelet counterpart of hemolytic disease of the fetus and newborn (HDFN). For around 3 decades, it has been common practice to treat immunized pregnant women with high-dose IVIg. Recent data will be presented that question the necessity of treating all immunized women with IVIg. A new hyperimmune anti-HPA-1a IgG has been developed with the aim of preventing HPA-1a immunization and FNAIT in HPA-1a negative women carrying an HPA-1a positive fetus. Results of a phase 1/2 clinical trial will be presented. A monoclonal antibody against the neonatal Fc receptor (FcRn) has been developed and is currently in clinical trial in women immunized against paternally-inherited antigens on fetal red blood cells. The possibility of extending this treatment modality to FNAIT will be discussed.
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