1
|
Hopkins M, Brookes J, Watson D, Wroe E, Guthrie P, Horler J, Anayattil K, Calvert A, Poles A. The first reported case of neonatal alloimmune thrombocytopenia due to low-frequency human platelet antigen-6b antibodies in the United Kingdom. Transfusion 2021; 61:2788-2794. [PMID: 34156106 DOI: 10.1111/trf.16563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neonatal alloimmune thrombocytopenia (NAIT) is a potentially serious clinical condition caused by maternal alloantibodies directed to human platelet antigens (HPA), inherited from the father and expressed on fetal/neonatal platelets. We report a case of an otherwise well, full term child, with a profound thrombocytopenia (33 x 109/L). There was no bleeding or obvious explanation for the low platelet count. Samples were sent for the investigation of NAIT. METHOD Serological investigations were performed on maternal serum taken at day (D)+4 and D+78. The platelet immunofluorescence test (PIFT) and monoclonal antibody immobilization of platelet antigens (MAIPA) assays were performed with a panel of HPA typed donor platelets and against paternal platelets in a crossmatch. HPA 1-6, -9 and -15 and HLA genotyping was performed by in-house PCR-sequence based typing (SBT) and next generation sequencing (NGS). RESULTS HPA antibody screening of D+4 maternal serum indicated that platelet-specific antibodies were absent. HPA genotyping of the father and child revealed the presence of the low frequency HPA antigen (LFHPA), HPA-6b, which was absent in the mother. Maternal samples were crossmatched against paternal platelets and were positive by PIFT and glycoprotein (GP) IIb/IIIa and HLA class I in the MAIPA assay. The infant required no platelet transfusion support as the thrombocytopenia resolved spontaneously. DISCUSSION We conclude that the positive crossmatch reaction was due to anti-HPA-6b alloantibodies. This case further emphasizes the importance of platelet crossmatching and HPA genotyping of LFHPA in cases where there is a high clinical suspicion of NAIT but initial screening is negative.
Collapse
Affiliation(s)
| | | | - David Watson
- Haematology Department, Ysbyty Maelor Hospital, Wrexham, United Kingdom
| | | | | | - Jane Horler
- H&I Department, NHSBT, Filton, United Kingdom
| | | | | | | |
Collapse
|
2
|
Porta R, Serrano P, Paltrinieri A, Ristic G, Canals C, Lozano M. Neonatal alloimmune thrombocytopenia due to anti-HPA 5a in a HPA-5a homozygous neonate. Transfus Apher Sci 2020; 59:102880. [PMID: 32763115 DOI: 10.1016/j.transci.2020.102880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
The most frequently involved antigen in severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the human platelet antigen 1a. Cases of FNAIT caused by HPA-5a antigen are extremely rare, and usually not severe. We report a case of FNAIT caused by anti-HPA antibodies directed to the HPA-5a antigen. The thrombocytopenia was moderate with a minimal platelet count of 36 × 109/L by day 3, and spontaneously resolved by day 10. The pregnancy had been obtained by in vitro fertilization using embryo donation, creating a complete genetic disparity between the HPA 5b5b mother and the HPA 5a5a homozygous neonate. The use of ART with gamete donation can increase the risk and the severity of alloimmune thrombocytopenia and must be considered in new and subsequent pregnancies.
Collapse
Affiliation(s)
- R Porta
- Hospital Dexeus, Pediatrics-Neonatology, Barcelona, Catalonia, Spain.
| | - P Serrano
- Hospital Dexeus, Pediatrics-Neonatology, Barcelona, Catalonia, Spain
| | - A Paltrinieri
- Hospital Dexeus, Pediatrics-Neonatology, Barcelona, Catalonia, Spain
| | - G Ristic
- Hospital Dexeus, Pediatrics-Neonatology, Barcelona, Catalonia, Spain
| | - C Canals
- Immunohematology Laboratory. Banc de Sang i Teixits. Barcelona, Catalonia, Spain
| | - M Lozano
- Hospital Dexeus, Transfusion Department, Barcelona, Catalonia, Spain
| |
Collapse
|
3
|
Dahl J, Skogen B, Kjaer M, Husebekk A, Kjeldsen-Kragh J, Tiller H. A combined effect of anti-HPA-1a and anti-HLA Class I in pregnancy? Transfusion 2020; 60:2121-2129. [PMID: 32608103 DOI: 10.1111/trf.15944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Maternal anti-human leukocyte antigen (HLA) Class I is commonly detected alongside anti-human platelet antigen (HPA)-1a in fetal and neonatal alloimmune thrombocytopenia (FNAIT). Little is known regarding whether the presence of anti-HLA Class I may exert an additive effect on the risk and severity of FNAIT. METHODS AND MATERIALS We reanalyzed samples originally collected as part of a large Norwegian screening study on FNAIT during 1995-2004. This study identified and managed 170 pregnancies where the mother was HPA-1a negative and had detectable anti-HPA-1a during pregnancy. Maternal samples from 166 of these pregnancies were rescreened for anti-HLA Class I, revealing 111 (67%) that were antibody positive. Various regression models were used to assess if and how maternal anti-HLA Class I influenced the neonatal platelet count. RESULTS AND CONCLUSIONS Unadjusted neonatal platelet counts and the frequency of neonatal thrombocytopenia was not significantly affected by the presence of anti-HLA Class I alongside anti-HPA-1a, but results from regression analyses revealed a possible increased risk when the mother was nulliparous. These results warrant further investigation.
Collapse
Affiliation(s)
- Jesper Dahl
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Skogen
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mette Kjaer
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Medicine, Clinical Research and Integrated Care, Finnmark Hospital Trust, Hammerfest, Norway
| | - Anne Husebekk
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens Kjeldsen-Kragh
- Department of Laboratory Medicine Diagnostic Clinic, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Immunology and Transfusion Medicine, University and Regional Laboratories Region Skåne, Lund, Sweden
| | - Heidi Tiller
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
4
|
Sachs UJ, Wienzek‐Lischka S, Duong Y, Qiu D, Hinrichs W, Cooper N, Santoso S, Bayat B, Bein G. Maternal antibodies against paternal class I human leukocyte antigens are not associated with foetal and neonatal alloimmune thrombocytopenia. Br J Haematol 2020; 189:751-759. [DOI: 10.1111/bjh.16419] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/01/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Ulrich J. Sachs
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
| | - Sandra Wienzek‐Lischka
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
| | - Yalin Duong
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
| | - Dan Qiu
- Institute for Medical Informatics Justus‐Liebig‐University Giessen Germany
| | | | - Nina Cooper
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
| | - Behnaz Bayat
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
| |
Collapse
|
5
|
Gimferrer I, Teramura G, Gallagher M, Warner P, Ji H, Chabra S. Implication of antibodies against human leukocyte antigen in simultaneous presentation of fetal and neonatal alloimmune thrombocytopenia and neutropenia. Transfus Apher Sci 2018; 57:773-776. [PMID: 30318177 DOI: 10.1016/j.transci.2018.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022]
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) and neonatal alloimmune neutropenia (NAN) are two rare complications of newborns caused by antibodies against paternal inherited antigens. Human platelet (HPA) and neutrophil antigens (HNA) are the common targets. Human leukocyte antigen (HLA) class I proteins are also expressed on platelets and neutrophils and anti-HLA antibodies have occasionally been implicated in these complications. We report a premature twin infant who presented with severe thrombocytopenia and neutropenia clinically compatible with FNAIT and NAN, from a mother with no identifiable HPA or HNA antibodies, but with very high levels of complement-fixing antibodies against paternal inherited HLA. These antibodies were also detected in the infant. HLA antibodies are commonly present in multiparous women who deliver healthy infants. They can, however, be cytotoxic and cause clinical complications after blood products transfusion (TRALI and becoming refractory to platelets transfusion) and after organ transplantation (allogeneic organ rejection).
Collapse
Affiliation(s)
| | | | | | | | - Hongxiu Ji
- Department of Pathology, Overlake Hospital Medical Center, Bellevue, WA, United States
| | - Shilpi Chabra
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, United States
| |
Collapse
|
6
|
Unraveling the role of maternal anti-HLA class I antibodies in fetal and neonatal thrombocytopenia—Antibody specificity analysis using epitope data. J Reprod Immunol 2017; 122:1-9. [DOI: 10.1016/j.jri.2017.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022]
|
7
|
Zhao H, Li B, Li N, Shen Y, Liu K, Shu X, Mei C, Tang L. Retrospective analysis of 55 twin neonates with haemolytic disease of the newborn. Immunol Res 2017; 65:699-705. [DOI: 10.1007/s12026-017-8902-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|