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Shad GA, Ghasemi A, Zadsar M, Shaeigan M, Samiee S, Zare A. PLT antigen discrepancy pattern among couples with recurrent abortion. Front Med (Lausanne) 2024; 11:1291779. [PMID: 38651057 PMCID: PMC11033322 DOI: 10.3389/fmed.2024.1291779] [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: 09/29/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Background Recurrent abortion refers to a condition of two or more consecutive pregnancies without known etiology affected by miscarriage before the completion of the 20th week of gestational age. However, several hypotheses have been proposed, but not much data are available concerning the relationship between human platelet antigens (HPAs) polymorphisms and recurrent abortion. This study was conducted to evaluate the genetic differences between HPA-1, -2, -3, -5, and - 15 in Iranian couples with a history of recurrent abortion. Methods In this cross-sectional study, a total of 74 couples with at least 2 recurrent abortions without any known specified reasons enrolled in the study. HPA polymorphisms genotyping was performed by single-specific primer PCR. Genotype frequency was calculated using the Hardy-Weinberg equation. Results A total of 39 couples (52.7%) had HPA genotyping partial mismatches. The most common partial mismatch pairs were found concomitantly on both HPA-15a and HPA-15b in three couples (4%), followed by two (2.7%) on HPA-3a and one (1.3%) in each HPA-2b and HPA-5b. There was a deviation from the Hardy-Weinberg equilibrium in the HPA-2 and -5 systems. Conclusion The present study declared that partial mismatches of HPA-3 and -15 genotypes were common among Iranian couples due to the history of recurrent abortion and approximately half of the couples carried at least one HPA gene that was absent in their partners. Further studies might be helpful to clarify the association between HPA polymorphisms and recurrent abortion, such as an investigation into the alloantibodies against HPAs.
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Affiliation(s)
| | - Ali Ghasemi
- Department of Biochemistry and Hematology, Faculty of Medicine Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Zadsar
- Infectious Disease Specialist, Blood Transfusion Research Center/High Institute for Research & Education in Transfusion Medicine/Microbiology Department, Tehran, Iran
| | - Mojgan Shaeigan
- Immunology, Blood Transfusion Research Center /High Institute for Research & Education in Transfusion Medicine, Immunohematology Department, Tehran, Iran
| | - Shahram Samiee
- Biochemistry, Iranian Blood Transfusion Organization Research Center, Tehran, Iran
| | - Ahad Zare
- Sarem Fertility and Infertility Research Center, Sarem Cell Research Center, Sarem Hospital, Tehran, Iran
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2
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Coucheron T, Uhrynowska M, Guz K, Orzińska A, Debska M, Gierszon A, Ahlen MT, Bertelsen EL, Berge G, Husebekk A, Brojer E, Tiller H. What's with the boys? Lower birth weight in boys from HPA-1a alloimmunized pregnancies - New insights from a large prospective screening study in Poland. J Reprod Immunol 2023; 160:104168. [PMID: 37992463 DOI: 10.1016/j.jri.2023.104168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
Fetomaternal incompatibility in human platelet antigens (HPAs) can cause maternal alloimmunization, which in turn may lead to thrombocytopenia with or without intracranial hemorrhage (ICH) in the fetus or newborn. Retrospective studies suggest that boys from alloimmunized mothers may have higher risk of ICH and lower birth weight than girls. The objective of this study was to assess how maternal HPA-1a alloimmunization, sex of the neonate and birth weight relates in a large prospective cohort. Through a national screening study in Poland (PREVFNAIT) involving HPA-1 typing of 24,259 pregnant women during 2013-2017, 606 HPA-1a negative pregnant women and their offspring were identified and included. Various multivariate models were used to assess if and how maternal HPA-1a alloimmunization status was associated with birth weight and risk of having a small for gestational age (SGA) neonate, and if and how sex of the neonate mattered. Most immunized pregnancies had male fetuses (69 %). Women carrying a male fetus had increased likelihood of having an SGA newborn if they were HPA-1a alloimmunized compared to non-immunized mothers. Increasing maternal anti-HPA-1a antibody levels were significantly associated with reduced birth weight and SGA risk among male-fetus pregnancies, but not if the fetus was female. In conclusion, anti-HPA-1a antibodies in a male fetus pregnancy is associated with increased risk of SGA and lower birth weight, especially if the antibody level is high. Sex of the fetus may therefore be considered as a new clinical predictor of more severe FNAIT neonatal outcome.
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Affiliation(s)
- Tina Coucheron
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Malgorzata Uhrynowska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Katarzyna Guz
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Agnieszka Orzińska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marzena Debska
- Medical Centre of Postgraduate Education, 2nd Department of Obstetrics and Gynaecology, Warsaw, Poland
| | - Agnieszka Gierszon
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Maria Therese Ahlen
- Norwegian National Unit for Platelet Immunology, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | | | - Gerd Berge
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Husebekk
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ewa Brojer
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Heidi Tiller
- Department of Gynecology and Obstetrics, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
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3
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Ahlen MT, Bussel JB. Desialylation unmasks HPA-9B alloantibodies. Blood 2023; 142:1853-1854. [PMID: 38032672 DOI: 10.1182/blood.2023022495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
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4
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Böhm D, Wienzek-Lischka S, Cooper N, Berghöfer H, Müller K, Bayat B, Bein G, Sachs UJ. Fetal and neonatal alloimmune thrombocytopenia: No evidence of systemic inflammation as a modulator of disease severity. Could placental inflammation be key? Br J Haematol 2023; 203:304-310. [PMID: 37571926 DOI: 10.1111/bjh.19009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
In fetal/neonatal alloimmune thrombocytopenia (FNAIT), maternal alloantibodies against paternal human platelet antigens (HPA) cross the placenta and lead to platelet destruction. The extent of thrombocytopenia varies among neonates, and inflammation may constitute an important trigger. A set of stable inflammatory markers was measured in serum samples from neonates with low platelet counts, of which n = 50 were diagnosed with FNAIT due to anti-HPA-1a antibodies and n = 50 were thrombocytopenic without detectable maternal HPA antibodies. Concentrations of C-reactive protein, soluble CD14, procalcitonin, and sFlt-1 did not differ between the two cohorts. There was no correlation between C-reactive protein or soluble CD14 and the platelet count, but a negative correlation between procalcitonin concentrations and the neonatal platelet count in both cohorts. sFlt-1 concentration and the platelet count were correlated in FNAIT cases exclusively. None of the inflammatory markers was statistically different between cases with and without intracranial haemorrhage. We were unable to identify systemic inflammation as a relevant factor for thrombocytopenia in FNAIT. The antiangiogenic enzyme sFlt-1, released by the placenta, did correlate with the platelet count in FNAIT cases. Our findings may give rise to the hypothesis that placental inflammation rather than systemic inflammation modulates disease severity in FNAIT.
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Affiliation(s)
- David Böhm
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
| | - Sandra Wienzek-Lischka
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
- German Center for Fetomaternal Incompatibility (DZFI), University Hospital Giessen and Marburg, Giessen, Germany
| | - Nina Cooper
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
- German Center for Fetomaternal Incompatibility (DZFI), University Hospital Giessen and Marburg, Giessen, Germany
| | - Heike Berghöfer
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
| | - Katja Müller
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
| | - Behnaz Bayat
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
| | - Gregor Bein
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
- German Center for Fetomaternal Incompatibility (DZFI), University Hospital Giessen and Marburg, Giessen, Germany
| | - Ulrich J Sachs
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
- German Center for Fetomaternal Incompatibility (DZFI), University Hospital Giessen and Marburg, Giessen, Germany
- Department of Thrombosis and Haemostasis, University Hospital Giessen and Marburg, Giessen, Germany
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5
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Liu QR, Liu JY, Zhao JY, Lin SB, Deng J, Xu XZ, Zhou Y. Do anti-CD36 antibodies cause only fetal/neonatal alloimmune thrombocytopenia? Br J Haematol 2023; 202:e62-e66. [PMID: 37455425 DOI: 10.1111/bjh.18969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Quan-Rui Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing-Yu Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing-Ya Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shao-Bin Lin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Deng
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Xiu-Zhang Xu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Yi Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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6
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Zemer VS, Mousa K, Herscovici T, Steinberg-Shemer O, Bonstein L, Yacobovich J. Neonatal Thrombocytopenia: Differing Characteristics of NAIT Versus Non-NAIT. J Pediatr Hematol Oncol 2023; 45:e728-e732. [PMID: 37027241 DOI: 10.1097/mph.0000000000002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/23/2023] [Indexed: 04/08/2023]
Abstract
While neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe neonatal thrombocytopenia good clinical predictors are lacking. We analyzed cases of neonatal thrombocytopenia in Schneider Children's Medical Center of Israel to pinpoint qualifiers of NAIT (NAIT+) in comparison to non-NAIT (NAIT-) thrombocytopenia. Patient and maternal data were retrospectively collected on all thrombocytopenic newborns undergoing a workup for NAIT in our tertiary center between 2001 and 2016. Among 26 thrombocytopenic neonates, the mean nadir in NAIT+ patients (25×10 9 /L) was significantly lower than NAIT- patients (64×10 9 /L) ( P <0.001). 61.5% of NAIT+ infants required treatment compared with 23% of non-NAIT ( P =0.015). NAIT+ patients also required more therapeutic modalities than infants with NAIT- thrombocytopenia. Human platelet antigen (HPA)-1a and HPA-5b alloantibodies most frequently caused NAIT. In summary, thrombocytopenia in NAIT+ was significantly more severe compared with NAIT- and more likely to require treatment. In addition, despite the varied ethnic population in Israel, the HPA alloantibodies found in our population were most similar to those common in Western countries. In the absence of rigorous prenatal screening options, we suggest platelet counts below 40 to 50×10 9 /L in a healthy newborn be considered most suggestive for NAIT and warrant urgent NAIT-specific analysis.
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Affiliation(s)
- Vered S Zemer
- Clalit Health Services
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | - Tina Herscovici
- Departments of Neonatology
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Orna Steinberg-Shemer
- Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Lilach Bonstein
- Blood Bank and Platelet Immunology Laboratories, Rambam Health Care Campus, Haifa, Israel
| | - Joanne Yacobovich
- Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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7
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Kiyokawa T, Mimura K, Nagamine K, Nakayama K, Horiuchi M, Morikawa T, Hosokawa M, Nakao M, Endo M, Kimura T, Kato H, Tomiyama Y, Kashiwagi H. FNAIT pathogenesis determined by serial analysis of three subsequent pregnancies of a woman with severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) with anti-HPA-4b and anti-HPA-5b alloantibodies in the first sibling. Int J Hematol 2023:10.1007/s12185-023-03559-1. [PMID: 36797397 DOI: 10.1007/s12185-023-03559-1] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by anti-HPA alloantibody, and anti-HPA-4b is the most common cause in Japanese. Anti-HPA-5b is frequently detected in pregnant women, but it is still controversial whether anti-HPA-5b causes severe FNAIT. CASE PRESENTATION A Japanese woman with anti-HPA-4b and anti-HPA-5b alloantibodies delivered a baby with severe FNAIT who was both HPA-4b and HPA-5b incompatible. We carefully monitored the patient's following three pregnancies (the second and the fourth siblings were HPA-4b incompatible and HPA-5b compatible; the third sibling was both HPA-4b and HPA-5b compatible). FNAIT was not observed in all three siblings, although a modest decrease in cord blood platelet count was observed in the HPA-4b incompatible siblings compared to the HPA-4b compatible sibling. Serial monitoring of anti-HPA titer showed that anti-HPA-4b markedly decreased in late pregnancy and recovered after delivery of the HPA-4b incompatible siblings, but these decreases were not observed during the mother's pregnancy with the HPA-4b compatible sibling. In contrast, anti-HPA-5b remained at a high titer during pregnancy with all three siblings. CONCLUSION Our data indicate that dynamic changes of anti-HPA-4b occur during pregnancy and strongly suggest that anti-HPA-5b was mainly responsible for severe FNAIT in this case.
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Affiliation(s)
- Tomoko Kiyokawa
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Keisuke Nagamine
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan
| | - Kotarosumitomo Nakayama
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan
| | - Mikiko Horiuchi
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan
| | - Tamayo Morikawa
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan
| | - Mika Hosokawa
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan
| | - Mayumi Nakao
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hisashi Kato
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshiaki Tomiyama
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hirokazu Kashiwagi
- Department of Blood Transfusion, Osaka University Hospital, Yamadaoka 2-15, Suita, Osaka, 565-0871, Japan.
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8
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Bussel JB, Vander Haar EL, Berkowitz RL. Fetal and neonatal alloimmune thrombocytopenia in 2022. Am J Obstet Gynecol 2023:S0002-9378(23)00064-9. [PMID: 36736677 DOI: 10.1016/j.ajog.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- James B Bussel
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Emilie L Vander Haar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY.
| | - Richard L Berkowitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
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9
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Stam W, Wachholz GE, de Pereda JM, Kapur R, van der Schoot E, Margadant C. Fetal and neonatal alloimmune thrombocytopenia: Current pathophysiological insights and perspectives for future diagnostics and treatment. Blood Rev 2022; 59:101038. [PMID: 36581513 DOI: 10.1016/j.blre.2022.101038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
FNAIT is a pregnancy-associated condition caused by maternal alloantibodies against paternally-inherited platelet antigens, most frequently HPA-1a on integrin β3. The clinical effects range from no symptoms to fatal intracranial hemorrhage, but underlying pathophysiological determinants are poorly understood. Accumulating evidence suggests that differential antibody-Fc-glycosylation, activation of complement/effector cells, and integrin function-blocking effects contribute to clinical outcome. Furthermore, some antibodies preferentially bind platelet integrin αIIbβ3, but others bind αvβ3 on endothelial cells and trophoblasts. Defects in endothelial cells and angiogenesis may therefore contribute to severe anti-HPA-1a associated FNAIT. Moreover, anti-HPA-1a antibodies may cause placental damage, leading to intrauterine growth restriction. We discuss current insights into diversity and actions of HPA-1a antibodies, gathered from clinical studies, in vitro studies, and mouse models. Assessment of all factors determining severity and progression of anti-HPA-1a-associated FNAIT may importantly improve risk stratification and potentially reveal novel treatment strategies, both for FNAIT and other immunohematological disorders.
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Affiliation(s)
- Wendy Stam
- Institute of Biology, Leiden University, Leiden, the Netherlands; Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Jose Maria de Pereda
- Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer, Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Salamanca, 37007 Salamanca, Spain.
| | - Rick Kapur
- Sanquin Research, Department of Experimental Immunohematology, Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ellen van der Schoot
- Sanquin Research, Department of Experimental Immunohematology, Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Coert Margadant
- Institute of Biology, Leiden University, Leiden, the Netherlands; Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
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10
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ABO Incompatibility between the Mother and Fetus Does Not Protect against Anti-Human Platelet Antigen-1a Immunization by Pregnancy. J Clin Med 2022; 11:jcm11226811. [PMID: 36431288 PMCID: PMC9694632 DOI: 10.3390/jcm11226811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
(1) Background: ABO blood group incompatibility between the mother and fetus protects against anti-D immunization by pregnancy. The possible role of ABO incompatibility in protecting against anti-human platelet antigen-1a immunization is unclear. (2) Methods: This study retrospectively screened 817 families (mother-father-neonate trios) of suspected fetal and neonatal alloimmune thrombocytopenia for inclusion. ABO genotypes were determined in 118 mother-child pairs with confirmed alloimmune thrombocytopenia due to anti-HPA-1a antibodies, and 522 mother-child pairs served as the control group. The expression of blood group antigen A on platelets was determined in 199 consecutive newborns by flow cytometry and compared with adult controls. (3) Results: ABO incompatibility between mother and fetus did not protect against anti-human platelet antigen-1a immunization by pregnancy. ABO blood groups of mothers and/or fetuses were not associated with the severity of fetal and neonatal alloimmune thrombocytopenia. The expression pattern of blood group A antigens on the platelets of newborns mirrored that of adults, albeit on a lower level. Blood group A antigen was detected on a subpopulation of neonatal platelets, and some newborns revealed high platelet expression of A determinants on all platelets (type II high-expressers). (4) Conclusion: The lack of a protective effect of ABO incompatibility between mother and fetus against anti-human platelet antigen-1a immunization by pregnancy may indicate that fetal platelets are not the cellular source by which the mother is immunized.
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11
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Zhi H, Sheridan D, Newman DK, Newman PJ. Prophylactic administration of HPA-1a-specific antibodies prevents fetal/neonatal alloimmune thrombocytopenia in mice. Blood 2022; 140:2146-2153. [PMID: 35881848 PMCID: PMC9837438 DOI: 10.1182/blood.2022015666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/20/2022] [Indexed: 01/21/2023] Open
Abstract
Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is a life-threatening bleeding disorder caused by maternal alloantibodies directed against paternally inherited human platelet alloantigens (HPAs) present on the surface of fetal and neonatal platelets. There are currently no approved therapies for the prevention of FNAIT. We report herein the ability of 2 human HPA-1a-specific therapeutic candidates, one a polyclonal, and the other a monoclonal antibody, to prevent alloimmunization in a novel preclinical mouse model of FNAIT. Both antibody preparations effected the rapid and complete elimination of HPA-1a+ platelets from circulation and prevented the development of HPA-1a alloantibodies. HPA-1a- female mice treated prophylactically with anti-HPA-1a antibody prior to exposure to HPA-1a+ platelets gave birth to HPA-1a+/- pups with significantly improved platelet counts and no bleeding symptoms. These preclinical data establish both the potential and threshold exposure targets for prophylactic treatment with HPA-1a-specific antibodies for the prevention of FNAIT in humans.
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Affiliation(s)
- Huiying Zhi
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI
| | | | - Debra K. Newman
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI
- Department of Pharmacology, Medical College of Wisconsin, Milwaukee, WI
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, WI
| | - Peter J. Newman
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI
- Department of Pharmacology, Medical College of Wisconsin, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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12
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de Vos TW, Winkelhorst D, Árnadóttir V, van der Bom JG, Canals Surís C, Caram-Deelder C, Deschmann E, Haysom HE, Hverven HBC, Lozar Krivec J, McQuilten ZK, Muñiz-Diaz E, Nogués N, Oepkes D, Porcelijn L, van der Schoot CE, Saxonhouse M, Sola-Visner M, Tiblad E, Tiller H, Wood EM, Young V, Železnik M, de Haas M, Lopriore E. Postnatal treatment for children with fetal and neonatal alloimmune thrombocytopenia: a multicentre, retrospective, cohort study. Lancet Haematol 2022; 9:e844-e853. [PMID: 36108655 DOI: 10.1016/s2352-3026(22)00243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Children affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT) are at risk of severe intracranial haemorrhage. Management in the postnatal period is based on sparse evidence. We aimed to describe the contemporary management and outcomes of patients with FNAIT in high-income countries. METHODS In this multicentre, retrospective, cohort study, we set up a web-based registry for the collection of deidentified data on the management and course of neonates with FNAIT. Eight centres from seven countries (Australia, Norway, Slovenia, Spain, Sweden, the Netherlands, and the USA) participated. Eligibility criteria comprised neonates with FNAIT being liveborn between Jan 1, 2010, and Jan 1, 2020; anti-human platelet antigen (HPA) alloantibodies in maternal serum; confirmed maternal and fetal HPA incompatibility; and bleeding detected at antenatal ultrasound, neonatal thrombocytopenia (<150 × 109 platelets per L), or both in the current or previous pregnancy. Clinical data were retrieved from local medical records of the first neonatal admission and entered in the registry. The key outcome was the type of postnatal treatment given to neonates with FNAIT. Other outcomes were daily median platelet counts in the first week of life, median platelet count increment after first unmatched versus first matched transfusions, and the proportion of neonates with mild or severe bleeding. FINDINGS 408 liveborn neonates with FNAIT were entered into the FNAIT registry, of whom 389 from Australia (n=74), Norway (n=56), Slovenia (n=19), Spain (n=55), Sweden (n=31), the Netherlands (n=138), and the USA (n=16) were included in our analyses. The median follow-up was 5 days (IQR 2-9). More neonates were male (241 [64%] of 379) than female (138 [36%]). Severe thrombocytopenia (platelet count <50 × 109 platelets per L) was reported in 283 (74%) of 380 neonates, and extreme thrombocytopenia (<10 × 109 platelets per L) was reported in 92 (24%) neonates. Postnatal platelet count nadir was higher in the no-treatment group than in all other groups. 163 (42%) of 389 neonates with FNAIT received no postnatal treatment. 207 (53%) neonates received platelet transfusions, which were either HPA-unmatched (88 [43%] of 207), HPA-matched (84 [41%]), or a combination of both (35 [17%]). The proportion of neonates who received HPA-matched platelet transfusions varied between countries, ranging from 0% (Slovenia) to 63% (35 of 56 neonates; Norway). Postnatal intravenous immunoglobulin treatment was given to 110 (28%) of 389 neonates (alone [n=19] or in combination with platelet transfusions [n=91]), with the proportion receiving it ranging from 12% (17 of 138 neonates; the Netherlands) to 63% (ten of 16 neonates; the USA) across countries. The median platelet increment was 59 × 109 platelets per L (IQR 35-94) after HPA-unmatched platelet transfusions and 98 × 109 platelets per L (67-134) after HPA-matched platelet transfusions (p<0·0001). Severe bleeding was diagnosed in 23 (6%) of 389 liveborn neonates, with one having a severe pulmonary haemorrhage and 22 having severe intracranial haemorrhages. Mild bleeding was diagnosed in 186 (48%) neonates. INTERPRETATION Postnatal management of FNAIT varies greatly between international centres, highlighting the absence of consensus on optimal treatments. Our data suggest that HPA-matched transfusions lead to a larger median platelet count increment than HPA-unmatched transfusions, but whether HPA matching is also associated with a reduced risk of bleeding remains unknown. FUNDING Sanquin.
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Affiliation(s)
- Thijs W de Vos
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands; Center of Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands; Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.
| | - Dian Winkelhorst
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands; Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
| | - Valgerdur Árnadóttir
- Department of Pediatrics, Division of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands; Center of Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands
| | - Emöke Deschmann
- Department of Pediatrics, Division of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Helen E Haysom
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hem Birgit C Hverven
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Jana Lozar Krivec
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zoe K McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Clinical Haematology, Monash Health, Melbourne, VIC, Australia
| | | | - Núria Nogués
- Immunohematology Laboratory, Blood and Tissue Bank, Barcelona, Spain
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | | | - Matthew Saxonhouse
- Division of Neonatology, Levine Children's Hospital, Atrium Healthcare, Wake Forest School of Medicine, Charlotte, NC, USA
| | - Martha Sola-Visner
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonor Tiblad
- Center for Fetal Medicine, Pregnancy Care and Delivery, Women's Health, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Heidi Tiller
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway; Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Clinical Haematology, Monash Health, Melbourne, VIC, Australia
| | - Vanessa Young
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mojca Železnik
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Masja de Haas
- Department of Hematology, Leiden University Medical Center, Leiden, Netherlands; Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands; Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands
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13
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Matusiak K, Patriquin CJ, Deniz S, Dzaja N, Smith JW, Wang G, Nazy I, Kelton JG, Arnold DM. Clinical and laboratory predictors of fetal and neonatal alloimmune thrombocytopenia. Transfusion 2022; 62:2213-2222. [PMID: 36239096 DOI: 10.1111/trf.17144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the most common cause of intracranial hemorrhage (ICH) in thrombocytopenic term infants. We investigated clinical and laboratory predictors of severe FNAIT in a tertiary care referral center. STUDY DESIGN AND METHODS Retrospective cohort study over a 30-year period. We defined FNAIT as recurrence of neonatal thrombocytopenia in a subsequent pregnancy; and severe outcomes as any of: (1) a birth platelet count below 20 × 109 /L; (2) ICH or (3) fetal death. We used a generalized estimating equations analysis and classification tree analysis to identify risk factors for severe FNAIT in a subsequent pregnancy. RESULTS During index pregnancies (n = 135 in 131 mothers), 71 infants (52.6%) had severe outcomes including a platelet count <20 × 109 /L (n = 45), fetal or neonatal ICH (n = 32), or fetal death (n = 4). During subsequent pregnancies (n = 72), 15 infants (20.8%) had severe outcomes including birth platelets <20 × 109 /L (n = 10), ICH (n = 2), or death (n = 3). Forty-two women (58.3%) received antenatal intravenous immune globulin (IVIG) during subsequent pregnancies. Eight mothers (n = 9 infants) had severe FNAIT outcomes despite receiving antenatal IVIG. Maternal antibodies to human platelet antigens (HPA) was the only independent predictor of severe FNAIT in a subsequent pregnancy (OR = 25.3, p = .004). Nevertheless, one of 43 infants from antibody-negative mothers had a severe outcome. CONCLUSIONS The presence of anti-HPA is highly indicative of the diagnosis of severe FNAIT; however, we observed one infant who had severe FNAIT recurrence, defined using strict clinical criteria, without a maternal antibody. Improved diagnostic and therapeutic strategies are needed to prevent severe FNAIT in high-risk mothers.
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Affiliation(s)
- Kristine Matusiak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher J Patriquin
- Department of Medicine, Division of Medical Oncology & Hematology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stacy Deniz
- Department of Obstetrics and Gynecology, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Dzaja
- Department of Obstetrics and Gynecology, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James W Smith
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Grace Wang
- McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ishac Nazy
- McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John G Kelton
- McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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14
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Gordana T, Koraljka G, Ruža G, Desiree CH, Ostojić SB, Branka GĆ. Severe intracranial haemorrhage in neonatal alloimmune thrombocytopenia due to antibodies against human platelet antigen 1b: Case report and literature review. Transfus Med 2022; 32:269-275. [PMID: 35730350 DOI: 10.1111/tme.12892] [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: 08/03/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 12/01/2022]
Abstract
Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is a rare life-threatening disorder, leading to severe thrombocytopenia and potentially bleeding, with intracranial haemorrhage (ICH) being the most serious complication. We report on a FNAIT case with fourth-degree ICH that arose due to antibodies against human platelet antigen (HPA)-1b. The male infant, born to an otherwise healthy mother, presented with severe signs of ICH soon after delivery. Since only moderate thrombocytopenia was noted and there were no active signs of bleeding, the infant did not receive intravenous immunoglobulins (IVIg) or platelet transfusion. Spontaneous recovery of platelets was noted on the eighth day of life, but permanent neurological impairment remained as a consequence of ICH. We report the results of HPA and human leukocyte antigen (HLA) antibodies in the mother's and the infant's sera, the family's HPA genotype and the mother's HLA genotype, and summarise previously described cases of FNAIT due to anti-HPA-1b antibodies in the literature. FNAIT with severe ICH due to anti-HPA-1b antibodies is rarely diagnosed. An association between HLA genes and sensitization to HPA-1b antibodies was not demonstrated. The severity of FNAIT and the occurrence of ICH is often difficult to predict. In this case, the infant presented with moderate thrombocytopenia and ICH, with subsequent permanent consequences.
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Affiliation(s)
- Tomac Gordana
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Gojčeta Koraljka
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Applied Health Sciences, Zagreb, Croatia
| | - Grizelj Ruža
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Coen Herak Desiree
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sanja Baršić Ostojić
- Clinical Department for Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Golubić Ćepulić Branka
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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15
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Alm J, Duong Y, Wienzek-Lischka S, Cooper N, Santoso S, Sachs UJ, Kiefel V, Bein G. Anti-human platelet antigen-5b antibodies and fetal and neonatal alloimmune thrombocytopenia; incidental association or cause and effect? Br J Haematol 2022; 198:14-23. [PMID: 35383895 DOI: 10.1111/bjh.18173] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 12/23/2022]
Abstract
Most cases of fetal and neonatal thrombocytopenia (FNAIT) are caused by maternal anti-human platelet antigen-1a antibodies (anti-HPA-1a). Anti-HPA-5b antibodies are the second most common antibodies in suspected FNAIT cases. Given the high prevalence of anti-HPA-5b antibodies in pregnant women delivering healthy newborns, the association with FNAIT may be coincidental. This review of the literature related to FNAIT using the MEDLINE database was conducted according to PRISMA guidelines. A retrospective analysis of a single-centre cohort of 817 suspected FNAIT cases was conducted. The pooled prevalence of anti-HPA-5b antibodies in unselected pregnant women of European descent was 1.96% (n = 3113), compared with 3.4% (n = 5003) in women with suspected FNAIT. We found weak evidence that a small proportion of pregnant women presenting with anti-HPA-5b antibodies will give birth to a newborn with mild thrombocytopenia. The neonatal platelet counts were not different between suspected FNAIT cases (n = 817) with and without maternal anti-HPA-5b antibodies. The prevalence of maternal anti-HPA-5b antibodies was not different between neonates with intracranial haemorrhage and healthy controls. The current experimental and epidemiological evidence does not support the hypothesis that anti-HPA-5b antibodies cause severe thrombocytopenia or bleeding complications in the fetus or newborn.
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Affiliation(s)
- Julia Alm
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - Yalin Duong
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - Sandra Wienzek-Lischka
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany.,German Centre for Fetomaternal Incompatibility, University Hospital Giessen and Marburg, Giessen, Germany
| | - Nina Cooper
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany.,German Centre for Fetomaternal Incompatibility, University Hospital Giessen and Marburg, Giessen, Germany
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - Ulrich J Sachs
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany.,German Centre for Fetomaternal Incompatibility, University Hospital Giessen and Marburg, Giessen, Germany.,Department of Thrombosis and Hemostasis, University Hospital Giessen and Marburg, Giessen, Germany
| | - Volker Kiefel
- Institute for Transfusion Medicine, University of Rostock, Rostock, Germany
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany.,German Centre for Fetomaternal Incompatibility, University Hospital Giessen and Marburg, Giessen, Germany
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16
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Xu X, Chen D, Ye X, Xia W, Xu Y, Chen Y, Shao Y, Deng J, Ding H, Liu J, Wang J, Ni H, Fu Y, Santoso S. Successful prenatal therapy for anti-CD36-mediated severe FNAIT by deglycosylated antibodies in a novel murine model. Blood 2021; 138:1757-1767. [PMID: 34041523 PMCID: PMC8701625 DOI: 10.1182/blood.2021011131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/01/2021] [Indexed: 11/20/2022] Open
Abstract
Recent studies have shown that maternal anti-CD36 antibodies represent a frequent cause of fetal/neonatal alloimmune thrombocytopenia (FNAIT) in Asian and African populations. However, little is known about the pathomechanism and antenatal treatment of anti-CD36-mediated FNAIT. Here, we established a novel animal model to examine the clinical features of pups from immunized Cd36-/- female mice after breeding with wild-type male mice. Mild thrombocytopenia was observed, but high pup mortality was also documented (40.26%). Administration of intravenous immunoglobulin (IVIG) (1 g/kg) on days 7, 12, and 17 to immunized Cd36-/- mothers after breeding reduced fetal death (12.70%). However, delaying the IVIG administration series on days 10, 15, and 20 did not reduce fetal death (40.00%). In contrast, injection of deglycosylated anti-CD36 (deg-anti-CD36) polyclonal antibodies (5 mg/kg) on days 10, 15, and 20 significantly reduced fetal death (5.26%). Subsequently, monoclonal antibodies (mAbs) against mouse CD36 were developed, and one clone producing high-affinity anti-CD36 (termed 32-106) effectively inhibited maternal antibody binding and was therefore selected. Using the same approach of deg-anti-CD36, the administration of deg-32-106 significantly reduced fetal death (2.17%). Furthermore, immunized Cd36-/- mothers exhibited placental deficiency. Accordingly, maternal anti-CD36 antibodies inhibited angiogenesis of placenta endothelial cells, which could be restored by deg-32-106. In summary, maternal anti-CD36 antibodies caused a high frequency of fetal death in our animal model, associated with placental dysfunction. This deleterious effect could be diminished by the antenatal administration of IVIG and deg-mAb 32-106. Interestingly, treatment with deg-32-106 seems more beneficial considering the lower dose, later start of treatment, and therapy success.
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Affiliation(s)
- Xiuzhang Xu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Dawei Chen
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Xin Ye
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Wenjie Xia
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Yaori Xu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Yangkai Chen
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Yuan Shao
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Jing Deng
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Haoqiang Ding
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Jing Liu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Jiali Wang
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Heyu Ni
- Department of Laboratory Medicine and Pathobiology, LKSKI-Keenan Research Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Canadian Blood Services Centre for Innovation, Toronto, ON, Canada
| | - Yongshui Fu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, Guangdong, China; and
- Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Sentot Santoso
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
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17
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Curtis BR. Are HPA-5b antibodies a significant cause of FNAIT and associated bleeding or merely an incidental finding? Br J Haematol 2021; 195:485-486. [PMID: 34402050 DOI: 10.1111/bjh.17763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Brian R Curtis
- Blood Center of Wisconsin, Platelet & Neutrophil Immunology Lab, Versiti, Milwaukee, WI, USA
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18
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Flesch BK, Carbol A. Diagnostik und Therapie einer Anti-CD36-induzierten neonatalen Alloimmunthrombozytopenie. TRANSFUSIONSMEDIZIN 2021. [DOI: 10.1055/a-1342-1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungMütterliche Antikörper gegen das HPA-1a auf kindlichen Thrombozyten sind der Hauptverursacher einer fetalen oder neonatalen Alloimmunthrombozytopenie (FNAIT). In asiatischen Populationen wurden wiederholt Isoantikörper gegen CD36 als ursächlich im Zusammenhang mit der FNAIT beschrieben, wohingegen in Mitteleuropa die CD36-Defizienz und damit die Möglichkeit einer Immunisierung praktisch unbekannt sind. Das erschwert deutlich die Transfusion mit kompatiblen Thrombozyten bei FNAIT-Fällen, z. B. bei Neugeborenen asiatischer Abstammung. Bei einem Neugeborenen arabischstämmiger Eltern wurde eine Anti-CD36-induzierte FNAIT diagnostiziert. Die Thrombozytenwerte konnten erfolgreich durch die Gabe HPA-unausgewählter Apheresethrombozytenkonzentrate (ATK) stabilisiert werden. Durch ein vorangegangenes Forschungsprojekt zum CD36-Screening bei Blutspendern arabischer Herkunft stand zusätzlich kurz darauf ein ATK mit sehr schwacher CD36-Expression zur Verfügung, das aber nicht mehr benötigt wurde. Dieser Fall weist somit alternative Therapiemöglichkeiten bei einer Anti-CD36-induzierten FNAIT auf.
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Affiliation(s)
- Brigitte K. Flesch
- DRK Blutspendedienst Rheinland-Pfalz und Saarland, Bad Kreuznach, Deutschland
| | - Alexander Carbol
- DRK Blutspendedienst Rheinland-Pfalz und Saarland, Bad Kreuznach, Deutschland
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19
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Bussel JB, Vander Haar EL, Berkowitz RL. New developments in fetal and neonatal alloimmune thrombocytopenia. Am J Obstet Gynecol 2021; 225:120-127. [PMID: 33839095 DOI: 10.1016/j.ajog.2021.04.211] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 01/18/2023]
Abstract
Fetal and neonatal alloimmune thrombocytopenia, the platelet equivalent of hemolytic disease of the fetus and newborn, can have devastating effects on both the fetus and neonate. Current management of fetal and neonatal alloimmune thrombocytopenia in a subsequent affected pregnancy involves antenatal administration of intravenous immune globulin and prednisone to the pregnant woman to prevent the development of severe fetal thrombocytopenia and secondary intracranial hemorrhage in utero. That therapy has proven to be highly effective but is associated with maternal side effects and is expensive. This commentary describes 4 advances that could substantially change the current approach to detecting and managing fetal and neonatal alloimmune thrombocytopenia in the near future. The first would be an introduction of a program to screen all antepartum patients in this country for pregnancies at risk of developing fetal and neonatal alloimmune thrombocytopenia. Strategies to implement this complex process have been described. A second advance is testing of cell-free fetal DNA obtained from maternal blood to noninvasively determine the fetal human platelet antigen 1 genotype. A third, in preliminary development, is creation of a prophylactic product that would be the platelet equivalent of Rh immune globulin (RhoGAM). Finally, a fourth major potential advance is the development of neonatal Fc receptor inhibitors to replace the current medical therapy administered to pregnant women with an affected fetus. Neonatal Fc receptor recycles plasma immunoglobulin G to increase its half-life and is the means by which immunoglobulin G crosses the placenta from the maternal to the fetal circulation. Blocking the neonatal Fc receptor is an ideal way to prevent maternal immunoglobulin G antibody from causing fetal and neonatal alloimmune thrombocytopenia in a fetus at risk of developing that disorder. The pertinent pathophysiology and rationale for each of these developments will be presented in addition to our thoughts relating to steps that must be taken and difficulties that each approach would face for them to be successfully implemented.
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20
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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.
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Affiliation(s)
| | | | - David Watson
- Haematology Department, Ysbyty Maelor Hospital, Wrexham, United Kingdom
| | | | | | - Jane Horler
- H&I Department, NHSBT, Filton, United Kingdom
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21
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Sachs UJ, Bedei I, Wienzek-Lischka S, Cooper N, Ehrhardt H, Axt-Fliedner R, Bein G. Fetale und neonatale Alloimmunthrombozytopenie, Teil 1. TRANSFUSIONSMEDIZIN 2021. [DOI: 10.1055/a-1258-1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie fetale und neonatale Alloimmunthrombozytopenie (FNAIT) wird durch mütterliche Antikörper hervorgerufen, die gegen ein vom Vater ererbtes Blutgruppenmerkmal an fetalen Thrombozyten gerichtet sind. Teil 1 des Beitrags stellt die Ätiologie, die Pathogenese und die Diagnostik der FNAIT dar, während Teil 2 die Risikostratifizierung und Behandlung der FNAIT thematisiert 1.
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22
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Toughza J, Agadr A, Nejjari M, Ammari IA. [Diagnosis and management of severe neonatal thrombocytopenia due to maternal alloimmunization against fetal platelet antigens: case study and literature review]. Pan Afr Med J 2020; 37:382. [PMID: 33796195 PMCID: PMC7992410 DOI: 10.11604/pamj.2020.37.382.24325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Thrombocytopenia is a common hematologic disorder in the neonatal period. It can occur in neonates hospitalized in the Intensive Care Unit and in preterm infants. It is characterized by a platelet count of less than 150.000/mm3. In the context of immune thrombocytopenia, neonatal thrombocytopenia due to maternal alloimmunization (estimated at 1 per 1000 live births) is not a rare event but it is often undiagnosed in minor forms. This is caused by maternal immunization against fetal platelet antigens inherited from the father and lacking in the mother. Maternal IgG alloantibodies cross the placenta causing fetal platelet destruction. In severe thrombocytopenia, consequences can be severe, with intracranial bleeding occurring in 10-30% of patients. Diagnosis is essentially based on clinical examination and must be suspected by pediatricians.
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Affiliation(s)
- Jihane Toughza
- Department of Pediatrics, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Aomar Agadr
- Department of Pediatrics, Mohammed V, Rabat, Morocco
| | - Mouad Nejjari
- Department of Pediatrics, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Insaf Al Ammari
- Department of Pediatrics, Mohammed VI University of Health Sciences, Casablanca, Morocco
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23
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Goldstein JA, Gallagher K, Beck C, Kumar R, Gernand AD. Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease. Front Immunol 2020; 11:531543. [PMID: 33281808 PMCID: PMC7691234 DOI: 10.3389/fimmu.2020.531543] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Events in fetal life impact long-term health outcomes. The placenta is the first organ to form and is the site of juxtaposition between the maternal and fetal circulations. Most diseases of pregnancy are caused by, impact, or are reflected in the placenta. The purpose of this review is to describe the main inflammatory processes in the placenta, discuss their immunology, and relate their short- and long-term disease associations. Acute placental inflammation (API), including maternal and fetal inflammatory responses corresponds to the clinical diagnosis of chorioamnionitis and is associated with respiratory and neurodevelopmental diseases. The chronic placental inflammatory pathologies (CPI), include chronic villitis of unknown etiology, chronic deciduitis, chronic chorionitis, eosinophilic T-cell vasculitis, and chronic histiocytic intervillositis. These diseases are less-well studied, but have complex immunology and show mechanistic impacts on the fetal immune system. Overall, much work remains to be done in describing the long-term impacts of placental inflammation on offspring health.
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Affiliation(s)
- Jeffery A. Goldstein
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kelly Gallagher
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Celeste Beck
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Rajesh Kumar
- Section of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital and Northwestern University, Chicago, IL, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
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24
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Warkentin TE. Challenges in Detecting Clinically Relevant Heparin-Induced Thrombocytopenia Antibodies. Hamostaseologie 2020; 40:472-484. [PMID: 33091948 PMCID: PMC7581458 DOI: 10.1055/a-1223-3329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated hypercoagulable state featuring high thrombosis risk and distinct pathogenesis involving immunoglobulin G-mediated platelet activation. The target of the immune response is a cationic “self” protein, platelet factor 4 (PF4), rendered antigenic by heparin. A key problem is that only a minority of anti-PF4/polyanion antibodies induced by heparin are pathogenic, i.e., capable of causing platelet activation and thereby clinical HIT. Since thrombocytopenia occurs frequently in hospitalized, heparin-treated patients, testing for “HIT antibodies” is common; thus, the problem of distinguishing between pathogenic and nonpathogenic antibodies is important. The central concept is that those antibodies that have platelet-activating properties demonstrable in vitro correlate well with pathogenicity, as shown by platelet activation tests such as the serotonin-release assay (SRA) and heparin-induced platelet activation assay. However, in most circumstances, immunoassays are used for first-line testing, and so it is important for clinicians to appreciate which immunoassay result profiles—in the appropriate clinical context—predict the presence of platelet-activating antibodies (Bayesian analysis). Clinicians with access to rapid, on-demand HIT immunoassays (e.g., particle gel immunoassay, latex immunoturbidimetric assay, chemiluminescent immunoassay) can look beyond simple dichotomous result interpretation (“negative”/“positive”) and incorporate semiquantitative interpretation, where, for example, a strong-positive immunoassay result (or even combination of two immunoassays) points to a greater probability of detecting platelet-activating antibodies, and hence supporting a diagnosis of HIT. Recent recognition of “SRA-negative HIT” has increased the importance of semiquantitative interpretation of immunoassays, given that strong immunoassay reactivity is a potential clue indicating possible HIT despite a (false) negative platelet activation assay.
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Affiliation(s)
- Theodore E Warkentin
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Transfusion Medicine, Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada.,Service of Clinical Hematology, Hamilton Health Sciences, Hamilton General Hospital, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, Hamilton, Ontario, Canada
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25
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Holzwarth ST, Bayat B, Zhu J, Phuangtham R, Fischer L, Boeckelmann D, Röder L, Berghöfer H, Schmidt S, Bein G, Santoso S. Naturally occurring point mutation Cys460Trp located in the I-EGF1 domain of integrin β3 alters the binding of some anti-HPA-1a antibodies. Transfusion 2020; 60:2097-2107. [PMID: 32770549 DOI: 10.1111/trf.15960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by the destruction of platelets in the fetus or newborn by maternal platelet alloantibodies, mostly against human platelet antigen (HPA)-1a. Recent studies indicate that two anti-HPA subtypes exist: Type I reacts with epitopes residing on the plexin-semaphorin-integrin (PSI) and type II with plexin-semaphorin-integrin/integrin epidermal growth factor 1 (I-EGF1) domains of the β3 integrin. Here, we evaluated whether a Cys460Trp mutation in the I-EGF1 domain found in a patient with Glanzmann thrombasthenia can alter the binding of anti-HPA-1a. METHODS Stable HEK293 cell lines expressing wild-type and mutant αIIbβ3 and αvβ3 were generated to prove the reactivity of different antibodies against HPA-1a. RESULTS Flow cytometry analysis of wild-type (Cys460) and mutant (Trp460) expressed on HEK293 cells showed equal surface expression of αIIbβ3 and αvβ3. When tested with mutant αIIbβ3 cells, reduced binding was observed in Type II but not in Type I anti-HPA-1a. These results could be confirmed with platelets carrying Cys460Trp mutation. Interestingly, reduced binding of Type I antibodies was detected with mutant αvβ3 cells. Both antibody types were found in maternal sera from FNAIT cases by an antigen-capture assay with use of HEK293 transfected cells. CONCLUSIONS These observations confirm the existence of Type I and Type II anti-HPA-1a. Furthermore, this study underlines different immunogenicity of HPA-1a antigen(s) residing on either αIIbβ3 or αvβ3. Further analysis of FNAIT cases from mothers having a fetus with and without intracranial bleedings with use of such an approach may highlight the functional relevance of different anti-HPA-1a subtypes.
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Affiliation(s)
- Sarah Theresa Holzwarth
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Behnaz Bayat
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Jieqing Zhu
- Blood Research Institute, Milwaukee, Wisconsin, USA
| | - Roongaroon Phuangtham
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany.,Department of Transfusion Medicine and Clinical Microbiology, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Lars Fischer
- Department of Children Oncology, Haematology and Haemostaseology, University Leipzig, Leipzig, Germany
| | - Doris Boeckelmann
- Department of Hemostaseology, Division of Pediatric Hematology and Oncology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Lida Röder
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Heike Berghöfer
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Silke Schmidt
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Giessen, Germany
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26
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Winkelhorst D, de Vos TW, Kamphuis MM, Porcelijn L, Lopriore E, Oepkes D, van der Schoot CE, de Haas M. HIP (HPA-screening in pregnancy) study: protocol of a nationwide, prospective and observational study to assess incidence and natural history of fetal/neonatal alloimmune thrombocytopenia and identifying pregnancies at risk. BMJ Open 2020; 10:e034071. [PMID: 32690731 PMCID: PMC7375633 DOI: 10.1136/bmjopen-2019-034071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Fetal and neonatal alloimmune thrombocytopenia (FNAIT) may lead to severe fetal or neonatal bleeding and/or perinatal death. Maternal alloantibodies, targeted against fetal human platelet antigens (HPAs), can result thrombocytopenia and bleeding complications. In pregnancies with known immunisation, fetal bleeding can be prevented by weekly maternal intravenous immunoglobulin infusions. Without population-based screening, immunisation is only detected after birth of an affected infant. Affected cases that might have been prevented, when timely identified through population-based screening. Implementation is hampered by the lack of knowledge on incidence, natural history and identification of pregnancies at high risk of bleeding. We designed a study aimed to obtain this missing knowledge. METHODS AND ANALYSIS The HIP (HPA-screening in pregnancy) study is a nationwide, prospective and observational cohort study aimed to assess incidence and natural history of FNAIT as well as identifying pregnancies at high risk for developing bleeding complications. For logistic reasons, we invite rhesus D-negative or rhesus c-negative pregnant women, who take part in the Dutch population-based prenatal screening programme for erythrocyte immunisation, to participate in our study. Serological HPA-1a typing is performed and a luminex-based multiplex assay will be performed for the detection of anti-HPA-1a antibodies. Results will not be communicated to patients or caregivers. Clinical data of HPA-1a negative women and an HPA-1a positive control group will be collected after birth. Samples of HPA-1a immunised pregnancies with and without signs of bleeding will be compared with identify parameters for identification of pregnancies at high risk for bleeding complications. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the Medical Ethical Committee Leiden-The Hague-Delft (P16.002). Study enrolment began in March 2017. All pregnant women have to give informed consent for testing according to the protocol. Results of the study will be disseminated through congresses and publication in relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04067375.
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Affiliation(s)
- Dian Winkelhorst
- Obstetrics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- Department of Experimental Immunohematology, Sanquin, Amsterdam, The Netherlands
| | - Thijs W de Vos
- Department of Experimental Immunohematology, Sanquin, Amsterdam, The Netherlands
- Pediatrics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Marije M Kamphuis
- Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Noord-Holland, The Netherlands
| | - Leendert Porcelijn
- Immunohaematology Diagnostics, Sanquin Blood Supply Foundation, Amsterdam, Noord-Holland, The Netherlands
| | - Enrico Lopriore
- Pediatrics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Dick Oepkes
- Obstetrics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Center Amsterdam and Department of Experimental Immunohematology, University of Amsterdam and Sanquin, Amsterdam, The Netherlands
| | - Masja de Haas
- Department of Immunohaematology Diagnostics, Sanquin, Amsterdam, The Netherlands
- Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, Noord-Holland, The Netherlands
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27
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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.
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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
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Shaw J, Blakemore JK, Moomjy M. Preimplantation genetic testing for a monogenic disorder can prevent live births affected by fetal and neonatal alloimmune thrombocytopenia. Pediatr Blood Cancer 2020; 67:e28239. [PMID: 32285999 DOI: 10.1002/pbc.28239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/04/2020] [Accepted: 02/15/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Jacquelyn Shaw
- Department of Obstetrics and Gynecology, New York University Langone Fertility Center, New York, New York
| | - Jennifer K Blakemore
- Department of Obstetrics and Gynecology, New York University Langone Fertility Center, New York, New York
| | - Maureen Moomjy
- Department of Obstetrics and Gynecology, New York University Langone Fertility Center, New York, New York
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Human platelet antigen 1-6, 9 and 15 in the Iranian population: An anthropological genetic analysis. Sci Rep 2020; 10:7442. [PMID: 32366900 PMCID: PMC7198494 DOI: 10.1038/s41598-020-64469-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/15/2020] [Indexed: 11/09/2022] Open
Abstract
Human platelet antigens (HPAs) are membranous glycoproteins considered as alloantigens due to their polymorphisms. HPA-incompatibility in multiple pregnancies or blood transfusion can induce the development of alloantibodies leading to thrombocytopenia. The frequency of HPAs varies among populations, so that deep knowledge of HPA frequencies will help us to reduce those incompatibilities. Herein, we studied the allele and genotype frequencies of HPA1-6, HPA9, and HPA15 among the Iranians with intra- and inter-populations analyses on 36 worldwide populations with diverse ethnicities. The analysis shows that the HPA2 and HPA5 have the greatest differences in genotype distribution between the Iranians and other nations, although similar to other populations, the sole allele found in HPA4, 6, and 9 is “a”. Despite other HPAs, the most frequent allele in HPA15 is “b”, which is also abundant in HPA3. Hierarchical clustering indicates the highest degree of global similarity in HPA genotype frequency among Iranian, Argentinian, Brazilian, and German Turkish populations. Our findings can be applied to decrease the risk of alloimmunizations and platelet disorders, especially in neonates.
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30
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Ouzegdouh Mammasse Y, Chenet C, Drubay D, Martageix C, Cartron JP, Vainchenker W, Petermann R. A new efficient tool for non-invasive diagnosis of fetomaternal platelet antigen incompatibility. Br J Haematol 2020; 190:787-798. [PMID: 32266719 DOI: 10.1111/bjh.16593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/02/2020] [Indexed: 12/23/2022]
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the consequence of platelet destruction by maternal alloantibodies against fetal human platelet antigens (HPA). This may result in intracranial haemorrhages (ICH) or even fetal death. Currently, fetal HPA genotyping is performed using invasive procedures. Here, we carried out a proof-of-concept study for non-invasive prenatal diagnosis of fetal platelet genotyping in four HPA systems (HPA-1, -3, -5 and-15) by droplet digital polymerase chain reaction (ddPCR) using cell-free DNA extracts from the plasma of 47 pregnant women with suspected, or history of, FNAIT. Results showed that 74% (35/47) of pregnant women presented incompatibility in at least one HPA system, and 38% (18/47) of cases presented HPA-1 incompatibility, including nine women with multiple incompatibilities. ICH occurred in one case of profound fetal thrombocytopenia with HPA-15 incompatibility, confirming the need for non-invasive prenatal genotyping in systems other than HPA-1. Fetal HPA genotypes predicted by ddPCR were confirmed in all FNAIT cases after amniocentesis or delivery. Fetal HPA genotyping on maternal plasma based on ddPCR is a fast, safe and reliable non-invasive method. This technique will be useful for the early identification of pregnancies at high risk of FNAIT requiring antenatal management to minimize the risk of fetal/neonatal haemorrhage.
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Affiliation(s)
- Yasmine Ouzegdouh Mammasse
- Institut National de la Transfusion Sanguine (INTS), Département d'Immunologie Plaquettaire, Paris, France
| | - Christophe Chenet
- Institut National de la Transfusion Sanguine (INTS), Département d'Immunologie Plaquettaire, Paris, France
| | - Damien Drubay
- INSERM, U1018, CESP, Faculté de Médecine - Université Paris-Sud - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
| | - Corinne Martageix
- Institut National de la Transfusion Sanguine (INTS), Département d'Immunologie Plaquettaire, Paris, France
| | | | - William Vainchenker
- Institut National de la Transfusion Sanguine (INTS), Département d'Immunologie Plaquettaire, Paris, France.,INSERM, UMR 1287, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UMR1287, Gustave Roussy, Villejuif, France
| | - Rachel Petermann
- Institut National de la Transfusion Sanguine (INTS), Département d'Immunologie Plaquettaire, Paris, France.,Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université de Paris, Equipe ETRES (Ethics, Research, Translations), Paris, France
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Abstract
A diagnosis of fetal/neonatal alloimmune thrombocytopenia (FNAIT) is made if a platelet-specific antibody is detected in the mother and the fetus or newborn carries the cognate antigen. Some children will experience very low platelet counts or even intracranial hemorrhage with devastating consequences, whereas others are largely unaffected. At the moment, predictive tools to forecast the severity of FNAIT during pregnancy are not available and over- or under-treatment may put the mother or the fetus at risk. A number of potential modulators of FNAIT severity have been reported. Maternal immune responses differ in respect to the IgG subtype composition, the glycosylation pattern of the antibodies, their fine specificity, and their functional effects on platelets, the trophoblast, and endothelial cells. In addition, antibody levels are variable. The efficacy of IgG transfer and, on the fetal side, gender and inflammatory responses, were also investigated for their potential impact on FNAIT severity. These potential risk modulators are scrutinized for available experimental and clinical evidence. Antibody glycosylation and anti-endothelial activity are hot candidates which, most likely in conjunction with the antibody level, should be explored further as tools to stratify fetal risk.
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Affiliation(s)
- Ulrich J Sachs
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany; Center for Transfusion Medicine and Hemotherapy, University Hospital Giessen and Marburg, Marburg, Germany; German Center for Fetomaternal Incompatibility (DZFI), University Hospital Giessen and Marburg, Giessen, Germany.
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32
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Bayat B, Traum A, Berghöfer H, Werth S, Zhu J, Bein G, Sachs UJ, Santoso S. Current Anti-HPA-1a Standard Antibodies React with the β3 Integrin Subunit but not with αIIbβ3 and αvβ3 Complexes. Thromb Haemost 2019; 119:1807-1815. [PMID: 31587244 DOI: 10.1055/s-0039-1696716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fetal/neonatal alloimmune thrombocytopenia (FNAIT) results from maternal alloantibodies (abs) reacting with fetal platelets expressing paternal human platelet antigens (HPAs), mostly HPA-1a. Anti-HPA-1a abs, are the most frequent cause of severe thrombocytopenia and intracranial hemorrhage (ICH). OBJECTIVES Titration of anti-HPA-1a in maternal serum using standard National Institute for Biological Standards and Control (NIBSC) 03/152 is one diagnostic approach to predict the severity of FNAIT. Recently, we found three anti-HPA-1a subtypes reacting with the β3 subunit independently or dependently from complexes with αIIb and αv. Endothelial cell-reactive anti-αvβ3 abs were found predominantly in cases with ICH. Our aim was to assess whether available standard material represents all anti-HPA-1a subtypes. MATERIALS AND METHODS In this study, anti-HPA-1a sera (NIBSC 03/152) and human monoclonal antibodies (moabs) against HPA-1a (moabs 26.4 and 813) were evaluated using transfected cell lines expressing αIIbβ3, αvβ3 or monomeric cβ3. RESULTS Flow cytometry analyses with well-characterized murine moabs recognizing αIIbβ3, αvβ3, or β3 alone demonstrated that AP3 reacts compound-independently, whereas compound-dependent moabs Gi5 and 23C6 reacted only with complexes. NIBSC 03/152, moabs 26.4, and 813 against HPA-1a reacted like AP3, same results were obtained with monomeric cβ3 in immunoblotting. Antigen capture assay targeting endothelial cells showed anti-HPA-1a reactivity disappearance after cβ3 beads adsorption. Furthermore, in contrast to anti-HPA-1a abs from ICH cases, none of NIBSC 03/152, 26.4, and 813 inhibited tube formation. CONCLUSION These results suggest that current anti-HPA-1a standard material contains only the anti-β3 subtype. The absence of anti-αvβ3 makes NIBSC 03/152 less suitable as standard to predict the severity of FNAIT.
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Affiliation(s)
- Behnaz Bayat
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Annalena Traum
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Heike Berghöfer
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Silke Werth
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Jieging Zhu
- Blood Research Institute, Milwaukee, Wisconsin, United States
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Ulrich J Sachs
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany.,Center for Transfusion Medicine and Hemotherapy, University Hospital Marburg, Marburg, Germany
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
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Baker JM, Shehata N, Bussel J, Murphy MF, Greinacher A, Bakchoul T, Massey E, Lieberman L, Landry D, Tanael S, Arnold DM, Baidya S, Bertrand G, Kjaer M, Kaplan C, Kjeldsen-Kragh J, Oepkes D, Savoia H, Ryan G, Hume H. Postnatal intervention for the treatment of FNAIT: a systematic review. J Perinatol 2019; 39:1329-1339. [PMID: 30971767 DOI: 10.1038/s41372-019-0360-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality. STUDY DESIGN MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018. RESULT Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 × 109/L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion. CONCLUSION Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion.
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Affiliation(s)
- Jillian M Baker
- St. Michael's Hospital and The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Nadine Shehata
- Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Canada.,Center for Innovation, Canadian Blood Services, Toronto, Canada
| | | | - Michael F Murphy
- NHS Blood & Transplant, Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals and University of Oxford, Oxford, UK
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Tamam Bakchoul
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany.,University Hospital of Tuebingen, Tuebingen, Germany
| | - Edwin Massey
- Diagnostic and Therapeutic Services, NHS Blood and Transplant, Bristol, UK
| | - Lani Lieberman
- University Health Network, University of Toronto, Toronto, Canada
| | - Denise Landry
- Center for Innovation, Canadian Blood Services, Ottawa, Canada
| | - Susano Tanael
- Center for Innovation, Canadian Blood Services, Toronto, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University and Canadian Blood Services, Hamilton, Canada
| | - Shoma Baidya
- Australian Red Cross Blood Service, Brisbane, QLD, Australia
| | - Gerald Bertrand
- BloodCenter of Brittany - (EFS) Établissement Français du Sang, Rennes, France
| | - Mette Kjaer
- Finnmark Hospital Trust, Hammerfest, Norway.,University Hospital of North Norway, Tromsø, Norway
| | - Cécile Kaplan
- Retired and formerly Institut National de la Transfusion Sanguine, Paris, France
| | - Jens Kjeldsen-Kragh
- University Hospital of North Norway, Tromsø, Norway.,University and Regional Laboratories Region Skåne, Lund, Sweden
| | - Dick Oepkes
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Greg Ryan
- Mount Sinai Hospital, Toronto, Canada
| | - Heather Hume
- Division of Haematology/Oncology, CHU Sainte-Justine, University of Montreal, Montreal, Canada
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Yang Q, Lv X, Kong Y, Liu X, Shao M, Zhao Y, Xia N, Wang S, Li H. Timely diagnosis and treatment of neonatal alloimmune thrombocytopenia caused by anti HPA-3a antibody: A case report. Medicine (Baltimore) 2019; 98:e15440. [PMID: 31083173 PMCID: PMC6531177 DOI: 10.1097/md.0000000000015440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Neonatal alloimmune thrombocytopenia (NAIT) caused by anti HPA-3a antibody is rare, and the clinical features of the syndrome are not specific. PATIENT CONCERNS A male infant was noted to be irritable and physical examination revealed the presence of petechiae and bruising on the right arm and thigh after born. DIAGNOSES Platelet antibodies were investigated using the monoclonal antibody-specific immobilization of platelet antigens (MAIPA) assay, platelet genotyping (HPA 1-17) was performed by polymerase chain reaction technique with sequence-specific primers (PCR-SSP). The HPA genotype of the newborn was HPA-3a/b, while that of his mother and his father were HPA-3b/b and HPA-3a/a, respectively. The sera of newborn contained antibody against the platelet of newborn's father. The HPA antibody of the newborn was identified as anti HPA-3a. The newborn was confirmed as a patient of NAIT caused by anti HPA-3a antibody. INTERVENTIONS A single dose of intravenous immunoglobulin (IVIG) 1 g/kg was administered from day 3 to day 7. OUTCOMES At follow-up 3 months after discharge from the hospital, the baby was developing normally and had a normal platelet count (361 × 109/L). LESSONS NAIT caused by anti HPA-3a antibody is rare, and we believe this study can provide insights for diagnosing prospective cases. Prognosis of NAIT caused by HPA3a seems to be favorable if diagnosed and treated in a timely manner.
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Affiliation(s)
| | | | | | - Xin Liu
- Department of Blood Transfusion
| | | | | | | | | | - Huidong Li
- Department of Surgical Clinic, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Regan F, Lees CC, Jones B, Nicolaides KH, Wimalasundera RC, Mijovic A. Prenatal Management of Pregnancies at Risk of Fetal Neonatal Alloimmune Thrombocytopenia (FNAIT): Scientific Impact Paper No. 61. BJOG 2019; 126:e173-e185. [PMID: 30968555 DOI: 10.1111/1471-0528.15642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHAT IS IT?: Fetal neonatal alloimmune thrombocytopenia (FNAIT), also known as neonatal alloimmune thrombocytopenia (NAIT) or fetomaternal alloimmune thrombocytopenia (FMAIT), is a rare condition which affects a baby's platelets. This can put them at risk of problems with bleeding, particularly into the brain. One baby per week in the UK may be seriously affected and milder forms can affect one in every 1000 births. HOW IS IT CAUSED?: Platelets are blood cells that are very important in helping blood to clot. All platelets have natural proteins on their surface called human platelet antigens (HPAs). In babies, half of these antigens are inherited from the mother and half from the father. During pregnancy, some of the baby's platelets can cross into the mother's bloodstream. In most cases, this does not cause a problem. But in cases of FNAIT, the mother's immune system does not recognise the baby's HPAs that were inherited from the father and develops antibodies, which can cross the placenta and attack the baby's platelets. These antibodies are called anti-HPAs, and the commonest antibody implicated is anti-HPA-1a, but there are other rarer antibody types. If this happens, the baby's platelets may be destroyed causing their platelet count to fall dangerously low. If the platelet count is very low there is a risk to the baby of bleeding into their brain before they are born. This is very rare but if it happens it can have serious effects on the baby's health. HOW IS IT INHERITED?: A baby inherits half of their HPAs from its mother and half from its father. Consequently, a baby may have different HPAs from its mother. As the condition is very rare, and even if the baby is at risk of the condition we have no way of knowing how severely they will be affected, routine screening is not currently recommended. WHAT CAN BE DONE?: FNAIT is usually diagnosed if a previous baby has had a low platelet count. The parents are offered blood tests and the condition can be confirmed or ruled out. There are many other causes of low platelets in babies, which may also need to be tested for. As the condition is so rare, expertise is limited to specialist centres and normally a haematologist and fetal medicine doctor will perform and interpret the tests together. Fortunately, there is an effective treatment for the vast majority of cases called immunoglobulin, or IVIg. This 'blood product' is given intravenously through a drip every week to women at risk of the condition. It may be started from as early as 16 weeks in the next pregnancy, until birth, which would be offered at around 36-37 weeks. Less common treatments that may be considered depending on individual circumstances include steroid tablets or injections, or giving platelet transfusions to the baby. WHAT DOES THIS PAPER TELL YOU?: This paper considers the latest evidence in relation to treatment options in the management of pregnancies at risk of FNAIT. Specifically, we discuss the role of screening, when IVIg should be started, what dose should be used, and what evidence there is for maternal steroids. We also consider in very rare selected cases, the use of fetal blood sampling and giving platelet transfusions to the baby before birth. Finally, we consider the approaches to blood testing mothers to tell if babies are at risk, which is offered in some countries, and development of new treatments to reduce the risk of FNAIT.
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MESH Headings
- Antigens, Human Platelet
- Female
- Fetal Diseases/genetics
- Fetal Diseases/prevention & control
- Fetal Diseases/therapy
- Genetic Testing
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Infant, Newborn
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/therapy
- Integrin beta3
- Mass Screening/methods
- Medical History Taking
- Platelet Count
- Pregnancy
- Prenatal Care/methods
- Thrombocytopenia, Neonatal Alloimmune/diagnosis
- Thrombocytopenia, Neonatal Alloimmune/genetics
- Thrombocytopenia, Neonatal Alloimmune/prevention & control
- Thrombocytopenia, Neonatal Alloimmune/therapy
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36
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Lieberman L, Greinacher A, Murphy MF, Bussel J, Bakchoul T, Corke S, Kjaer M, Kjeldsen-Kragh J, Bertrand G, Oepkes D, Baker JM, Hume H, Massey E, Kaplan C, Arnold DM, Baidya S, Ryan G, Savoia H, Landry D, Shehata N. Fetal and neonatal alloimmune thrombocytopenia: recommendations for evidence-based practice, an international approach. Br J Haematol 2019; 185:549-562. [PMID: 30828796 DOI: 10.1111/bjh.15813] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) may result in severe bleeding, particularly fetal and neonatal intracranial haemorrhage (ICH). As a result, FNAIT requires prompt identification and treatment; subsequent pregnancies need close surveillance and management. An international panel convened to develop evidence-based recommendations for diagnosis and management of FNAIT. A rigorous approach was used to search, review and develop recommendations from published data for: antenatal management, postnatal management, diagnostic testing and universal screening. To confirm FNAIT, fetal human platelet antigen (HPA) typing, using non-invasive methods if quality-assured, should be performed during pregnancy when the father is unknown, unavailable for testing or heterozygous for the implicated antigen. Women with a previous child with an ICH related to FNAIT should be offered intravenous immunoglobulin (IVIG) infusions during subsequent affected pregnancies as early as 12 weeks gestation. Ideally, HPA-selected platelets should be available at delivery for potentially affected infants and used to increase the neonatal platelet count as needed. If HPA-selected platelets are not immediately available, unselected platelets should be transfused. FNAIT studies that optimize antenatal and postnatal management, develop risk stratification algorithms to guide management and standardize laboratory testing to identify high risk pregnancies are needed.
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Affiliation(s)
- Lani Lieberman
- University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Michael F Murphy
- National Health Service (NHS) Blood and Transplant and the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals and University of Oxford, Oxford, United Kingdom
| | | | | | | | - Mette Kjaer
- Finnmark Hospital Trust, Hammerfest, Norway.,University Hospital of North Norway, Tromsø, Norway
| | - Jens Kjeldsen-Kragh
- University Hospital of North Norway, Tromsø, Norway.,University and Regional Laboratories Region Skåne, Lund, Sweden
| | - Gerald Bertrand
- Blood Center of Brittany - EFS L'Établissement Français du Sang, Rennes, France
| | - Dick Oepkes
- Leiden University Medical Center, Leiden, the Netherlands
| | - Jillian M Baker
- Hospital for Sick Children and St. Michael's Hospital, Toronto, Canada
| | - Heather Hume
- CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | | | - Cécile Kaplan
- Retired and formerly Institut National de la Transfusion Sanguine, Paris, France
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University and Canadian Blood Services, Hamilton, Canada
| | - Shoma Baidya
- Australian Red Cross Blood Service, Brisbane, Australia
| | - Greg Ryan
- University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada
| | | | | | - Nadine Shehata
- University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada.,Canadian Blood Services, Toronto, Canada
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37
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Bertrand G, Blouin L, Boehlen F, Levine E, Minon JM, Winer N. Management of neonatal thrombocytopenia in a context of maternal antiplatelet alloimmunization: Expert opinion of the French-speaking working group. Arch Pediatr 2019; 26:191-197. [PMID: 30827773 DOI: 10.1016/j.arcped.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/13/2018] [Accepted: 02/03/2019] [Indexed: 01/07/2023]
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a potentially devastating disease, seen in 1/800-1000 neonates. FNAIT is the most common cause of early-onset isolated severe neonatal thrombocytopenia in maternity wards. The most feared complication of this disorder is intracranial hemorrhage, leading to death or neurological sequelae. There is no systematic screening of at-risk pregnancies and FNAIT is often discovered when fetal or neonatal bleeding is observed. A working group on fetomaternal platelet alloimmunization was created in 2017, under the auspices on the French Group of Thrombosis and Hemostasis (GFHT). The first objective of this group was to survey clinical practices for treatment of thrombocytopenic neonates in a context of suspected or confirmed FNAIT.
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Affiliation(s)
- G Bertrand
- laboratoire HLA-HPA, Établissement français du sang (EFS) Bretagne, rue Pierre-Jean-Gineste, BP 91614, 35016 Rennes cedex, France.
| | - L Blouin
- Laboratoire d'immunologie et immunogénétique, EFS Nouvelle Aquitaine, CHU de Bordeaux, place Amélie-Léon, 33076 Bordeaux cedex, France
| | - F Boehlen
- Service d'angiologie et d'hémostase, hôpitaux universitaires de Genève, 4, rue Gabrielle-Perret-Gentil, 1211 Genève 14, Switzerland
| | - E Levine
- Service de néonatologie soins intensifs, hôpital universitaire de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - J-M Minon
- Unité d'hémostase et de transfusion, département de médecine de laboratoire, centre hospitalier régional de la Citadelle, boulevard du XXII(e)-de-Ligne, 4000 Liège, Belgium
| | - N Winer
- INRA, UMR 1280, département de gynécologie et d'obstétrique, physiologie des adaptations nutritionnelles, hôpital universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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38
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Winkelhorst D, Oepkes D. Foetal and neonatal alloimmune thrombocytopenia. Best Pract Res Clin Obstet Gynaecol 2019; 58:15-27. [PMID: 30827816 DOI: 10.1016/j.bpobgyn.2019.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 12/19/2022]
Abstract
Foetal or neonatal thrombocytopenia results from alloimmunisation during pregnancy. Maternal alloantibodies can be formed following exposure to paternally derived human platelet antigens (HPAs) on foetal platelets, in case of incompatible HPA type. These alloantibodies are of the immunoglobulin G subclass and can therefore enter the foetal circulation through active placental transport mediated by the neonatal Fc-receptor. After entering the foetal circulation, these alloantibodies can cause destruction of foetal platelets and potentially damage other foetal cells containing the specific antigen. Subsequent clinical presentation in foetuses or neonates can vary widely, from an asymptomatic thrombocytopenia to a broad spectrum of bleeding complications. Most frequently encountered are minor skin haemorrhages, such as hematomas or petechiae, but also more devastating haemorrhages can occur. Of these, an intracranial haemorrhage is the most feared complication because of its high risk of life-long major neurological handicaps or perinatal death.
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Affiliation(s)
- Dian Winkelhorst
- Department of Obstetrics, Leiden University Medical Center, K6-35, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, K6-35, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
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39
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Hoste L, George I. Ranitidine-induced Thrombocytopenia in a Neonate - A Case Report and Review of Literature. J Pediatr Pharmacol Ther 2019; 24:66-71. [PMID: 30837818 DOI: 10.5863/1551-6776-24.1.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thrombocytopenia (platelet count <150 × 109/L) regularly occurs in newborns but is especially observed in critically ill neonates. We describe the case of a small for gestational age (SGA) neonate, who showed an unexpected, severe thrombocytopenia (8 × 109/L) at day 5 of life. The thrombocytopenia recovered completely after cessation of ranitidine (0.5 mg/kg/6 hr), which was started in a context of feeding difficulties. Other causes of neonatal thrombocytopenia were ruled out. Besides a brief report on a cimetidine-induced thrombocytopenia over 25 years ago, no other neonatal or pediatric cases of H2 antagonist-induced thrombocytopenia have been reported to date, although being widely used in routine care. Moreover, several adult cases have been published. In general, neonatal thrombocytopenia, although one of the most frequent hematological conditions in newborns, is only rarely attributed to an adverse drug reaction. Clinicians should be aware of the risks for adverse reactions, especially in routinely used drugs and in critically ill patients.
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42
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Bertrand G, Danger Y, Laurichesse M, Verite F, Renac V. A case of neonatal thrombocytopenia caused by maternal alloimmunization against a new platelet antigen (Bzh a , HPA-34bw) located on GPIIIa. Transfusion 2018; 59:1402-1403. [PMID: 30586473 DOI: 10.1111/trf.15120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Gérald Bertrand
- HLA-HPA Laboratory, BloodCenter of Brittany EFS, Rennes, France
| | - Yannic Danger
- EFS Bretagne, Plateforme des Biotechnologies Innovantes, Rennes, France
| | | | - Franck Verite
- EFS Bretagne, Plateforme des Biotechnologies Innovantes, Rennes, France
| | - Virginie Renac
- HLA-HPA Laboratory, BloodCenter of Brittany EFS, Rennes, France
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43
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Poles A, Lucas G, Green F, Walser P, Davey S, Ridgwell K, Wylie P. Neonatal alloimmune thrombocytopenia due to a new alloantigen Bl(a) defined by an Asp458Gly substitution in GPIIIa. Transfusion 2018; 59:396-404. [PMID: 30488955 DOI: 10.1111/trf.14990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/14/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neonatal alloimmune thrombocytopenia (NAIT) commonly arises due to antibodies against a small number of well-defined human platelet antigens (HPAs). A minority of NAIT cases occur due to maternal immunization against low-frequency polymorphisms in platelet glycoprotein that result in new immunogenic epitopes. Antibodies to these novel epitopes can be detected by the incubation of maternal serum with paternal platelets and is usually performed after initial investigation using HPA-typed panel platelets has failed to provide evidence of NAIT. STUDY DESIGN AND METHODS The propositus and the parents from a case of suspected neonatal alloimmune thrombocytopenia (NAIT) were investigated using serologic and molecular techniques to detect and identify relevant platelet-specific antibodies and for HPA typing. Calculations of molecular dynamics were undertaken to explore potential variations in the molecular structure. RESULTS Maternal antibodies were detected that were reactive only in crossmatch with paternal platelets using the platelet immunofluorescence test (PIFT) and a GPIIb/IIIa monoclonal antibody immobilization of platelet antigen (MAIPA) assay. In the propositus and father, a novel mutation c.1373 A > G was found in exon 10 of ITGB3 resulting in the substitution of an aspartic acid for a glycine (p.Asp458Gly). Recombinant GPIIIa glycoprotein mutated to contain the novel mutation and expressed in HEK293 cells with GPIIb was also specifically recognized by maternal antibodies. Calculations of molecular dynamics identified that the mutation was in a structurally constrained site. CONCLUSION This case describes a low-frequency platelet antigen (Asp458Gly) that defines a further alloantigenic target in NAIT. The case emphasizes the role of the platelet crossmatch as the single most useful tool to establish evidence of immunization of low-frequency platelet glycoprotein polymorphisms. A crossmatch should always be performed where there is strong clinical evidence of NAIT but initial laboratory investigations are not confirmatory.
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Affiliation(s)
- Anthony Poles
- Histocompatibility and Immunogenetics, NHSBT, North Bristol Park, Filton, Bristol, UK
| | - Geoff Lucas
- Histocompatibility and Immunogenetics, NHSBT, North Bristol Park, Filton, Bristol, UK
| | - Frances Green
- International Blood Group Reference Laboratory (IBGRL), NHSBT, North Bristol Park, Filton, Bristol, UK
| | - Piers Walser
- International Blood Group Reference Laboratory (IBGRL), NHSBT, North Bristol Park, Filton, Bristol, UK
| | - Sue Davey
- Histocompatibility and Immunogenetics, NHSBT, Charcot Road, Colindale, London, UK
| | - Kay Ridgwell
- International Blood Group Reference Laboratory (IBGRL), NHSBT, North Bristol Park, Filton, Bristol, UK
| | - Philip Wylie
- Department of Paediatrics, Dorset County Hospital, Dorchester, UK
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44
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Zhi H, Ahlen MT, Thinn AMM, Weiler H, Curtis BR, Skogen B, Zhu J, Newman PJ. High-resolution mapping of the polyclonal immune response to the human platelet alloantigen HPA-1a (Pl A1). Blood Adv 2018; 2:3001-3011. [PMID: 30413435 PMCID: PMC6234362 DOI: 10.1182/bloodadvances.2018023341] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022] Open
Abstract
Antibodies to platelet-specific antigens are responsible for 2 clinically important bleeding disorders: posttransfusion purpura and fetal/neonatal alloimmune thrombocytopenia (FNAIT). The human platelet-specific alloantigen 1a/1b (HPA-1a/1b; also known as PlA1/A2) alloantigen system of human platelet membrane glycoprotein (GP) IIIa is controlled by a Leu33Pro polymorphism and is responsible for ∼80% of the cases of FNAIT. Local residues surrounding polymorphic residue 33 are suspected to have a profound effect on alloantibody binding and subsequent downstream effector events. To define the molecular requirements for HPA-1a alloantibody binding, we generated transgenic mice that expressed murine GPIIIa (muGPIIIa) isoforms harboring select humanized residues within the plexin-semaphorin-integrin (PSI) and epidermal growth factor 1 (EGF1) domains and examined their ability to support the binding of a series of monoclonal and polyclonal HPA-1a-specific antibodies. Humanizing the PSI domain of muGPIIIa was sufficient to recreate the HPA-1a epitope recognized by some HPA-1a-specific antibodies; however, humanizing distinct amino acids within the linearly distant but conformationally close EGF1 domain was required to enable binding of others. These results reveal the previously unsuspected complex heterogeneity of the polyclonal alloimmune response to this clinically important human platelet alloantigen system. High-resolution mapping of this alloimmune response may improve diagnosis of FNAIT and should facilitate the rational design and selection of contemplated prophylactic and therapeutic anti-HPA-1a reagents.
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Affiliation(s)
- Huiying Zhi
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI
| | - Maria Therese Ahlen
- Immunology Research Group, Department of Medical Biology, The Arctic University of Norway, Tromsø, Norway
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Aye Myat Myat Thinn
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI
- Department of Biochemistry
| | - Hartmut Weiler
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI
| | - Brian R Curtis
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI
| | - Bjørn Skogen
- Immunology Research Group, Department of Medical Biology, The Arctic University of Norway, Tromsø, Norway
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Jieqing Zhu
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI
- Department of Biochemistry
| | - Peter J Newman
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI
- Department of Pharmacology, and
- Department of Cell Biology, Medical College of Wisconsin, Milwaukee, WI
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45
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Ferro M, Macher HC, Fornés G, Martín-Sánchez J, Jimenez-Arriscado P, Molinero P, Pérez-Simón JA, Guerrero JM, Rubio A. Noninvasive prenatal diagnosis by cell-free DNA screening for fetomaternal HPA-1a platelet incompatibility. Transfusion 2018; 58:2272-2279. [PMID: 30222855 DOI: 10.1111/trf.14837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/15/2018] [Accepted: 04/15/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The development of new noninvasive approaches for the diagnosis of human platelet antigen (HPA)-1 fetomaternal incompatibility has become of great interest. These approaches allow determination of whether the fetus is incompatible or not with the mother and a decision on antenatal therapy to avoid fetal or neonatal alloimmune thrombocytopenia (FNAIT). The objective of this work was to perform rapid, noninvasive prenatal test for HPA-1ab fetal antigen detection after the detection of an HPA-1-homozygous mother by using plasma cell-free DNA (cfDNA). STUDY DESIGN AND METHODS The HPA-1 genotypes of 142 pregnant women and 17 nonpregnant controls were retrospectively determined by high-resolution melting (HRM) polymerase chain reaction (PCR). Coamplification at lower denaturation temperature (COLD) HRM PCR was performed to determine the fetal genotype analyzing cfDNA from all HPA-1bb pregnant women. RESULTS After the HRM analysis, the following genotypes were identified: HPA-1aa (71.13%), HPA-1bb (2.8%), and HPA-1ab (26.06%). Four HPA-1bb-homozygous pregnant women were carrying an incompatible fetus. Plasma samples from these mothers were analyzed by HRM COLD-PCR. Homozygous HPA-1bb pregnant women carrying an HPA-1ab-heterozygous fetus did not group with either the HPA-1ab or the HPA-1bb controls. Thus, COLD-PCR analysis allows the detection of HPA-1ab-heterozygous fetuses carried by homozygous mothers during first weeks of pregnancy. CONCLUSION The fetal genotype from HPA-1bb-homozygous women was detected by a noninvasive prenatal test as soon as 12 weeks of gestation.
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Affiliation(s)
- Marta Ferro
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Hospital Universitario Virgen del Rocío-Universidad de Sevilla, Seville, Andalucía, Spain
| | - Hada C Macher
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Hospital Universitario Virgen del Rocío-Universidad de Sevilla, Seville, Andalucía, Spain
| | - Gema Fornés
- the Blood Transfusion Center and Tissue and Cells Establishment Córdoba, Cordoba, Andalucía, Spain
| | - Jesús Martín-Sánchez
- the Departmento de Hematología, Hospital Universitario Virgen del Rocío, Seville, Andalucía, Spain
| | - Pilar Jimenez-Arriscado
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Hospital Universitario Virgen del Rocío-Universidad de Sevilla, Seville, Andalucía, Spain
| | - Patrocinio Molinero
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Hospital Universitario Virgen del Rocío-Universidad de Sevilla, Seville, Andalucía, Spain
| | - José A Pérez-Simón
- the Departmento de Hematología, Hospital Universitario Virgen del Rocío, Seville, Andalucía, Spain
| | - Juan M Guerrero
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Hospital Universitario Virgen del Rocío-Universidad de Sevilla, Seville, Andalucía, Spain
| | - Amalia Rubio
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Hospital Universitario Virgen del Rocío-Universidad de Sevilla, Seville, Andalucía, Spain
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Pina-Cabral LB, Carvalhais V, Mesquita B, Escórcio C, Silva PF, Pinto P, Napoleão P, Pinheiro T, Monteiro MC, Almeida-Dias A, Criado B. Myocardial infarction before and after the age of 45: Possible role of platelet receptor polymorphisms. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pina-Cabral LB, Carvalhais V, Mesquita B, Escórcio C, Silva PF, Pinto P, Napoleão P, Pinheiro T, Monteiro MC, Almeida-Dias A, Criado B. Myocardial infarction before and after the age of 45: Possible role of platelet receptor polymorphisms. Rev Port Cardiol 2018; 37:727-735. [DOI: 10.1016/j.repc.2018.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/03/2018] [Accepted: 03/11/2018] [Indexed: 11/28/2022] Open
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Dębska M, Uhrynowska M, Guz K, Kopeć I, Lachert E, Orzińska A, Kretowicz P, Antoniewicz-Papis J, Dębski R, Łętowska M, Husebekk A, Brojer E. Identification and follow-up of pregnant women with platelet-type human platelet antigen (HPA)-1bb alloimmunized with fetal HPA-1a. Arch Med Sci 2018; 14:1041-1047. [PMID: 30154886 PMCID: PMC6111341 DOI: 10.5114/aoms.2016.63600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/21/2016] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Pregnant women negative for human platelet antigen 1a (HPA-1a) are at risk of alloimmunization with fetal HPA-1a antigen inherited from the father, and their offspring may develop fetal and neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to analyze the frequency of HPA-1a alloimmunization in pregnant Polish women, the feasibility of using maternal platelets for intrauterine transfusions in women subjected to diagnostic fetal blood sampling (FBS) and to discuss potential consequences of alloimmunization. MATERIAL AND METHODS Fifteen thousand two hundred and four pregnant women were typed for HPA-1a; HPA-1a negative were screened for anti-HPA-1a. Alloimmunized women received specialist perinatology care; some of them were subjected to FBS, followed by transfusion of HPA-1a negative platelet concentrates (PC) prepared from maternal blood. RESULTS Three hundred seventy-three (2.5%) women were HPA-1a negative, and 32 (8.6%) tested positively for anti-HPA-1a. Antibodies were detected in 22 women during pregnancy. Diagnostic FBS followed by PC transfusion was performed in 14 woman, who were platelet donors for their 16 unborn babies. Blood donations were tolerated well by the patients, and also intrauterine platelet transfusions were uneventful. Pharmacotherapy with intravenous immunoglobulins was implemented in 11/22 patients. CONCLUSIONS HPA-1a negative women (ca. 2.5% of all pregnant patients) are at risk of alloimmunization with HPA-1a antigen and developing FNAIT. Alloimmunized women can be donors of platelets for their offspring providing removal of antibodies from PC. Owing to potential complications, special care should be taken if an alloimmunized woman was qualified as a blood or stem cell recipient.
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Affiliation(s)
- Marzena Dębska
- 2 Ward of Obstetrics and Gynecology, Medical Center for Postgraduate Education (CMKP), Warsaw, Poland
| | - Małgorzata Uhrynowska
- Department of Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Katarzyna Guz
- Department of Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Izabella Kopeć
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Elżbieta Lachert
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Agnieszka Orzińska
- Department of Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Piotr Kretowicz
- 2 Ward of Obstetrics and Gynecology, Medical Center for Postgraduate Education (CMKP), Warsaw, Poland
| | - Jolanta Antoniewicz-Papis
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Romuald Dębski
- 2 Ward of Obstetrics and Gynecology, Medical Center for Postgraduate Education (CMKP), Warsaw, Poland
| | - Magdalena Łętowska
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Anne Husebekk
- Institute of Medical Biology, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Ewa Brojer
- Department of Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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Platelet-Activating Antibodies Are Detectable at the Earliest Onset of Heparin-Induced Thrombocytopenia, With Implications for the Operating Characteristics of the Serotonin-Release Assay. Chest 2018; 153:1396-1404. [DOI: 10.1016/j.chest.2018.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/01/2017] [Accepted: 01/02/2018] [Indexed: 11/21/2022] Open
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Winkelhorst D, Kamphuis MM, Steggerda SJ, Rijken M, Oepkes D, Lopriore E, van Klink JMM. Perinatal Outcome and Long-Term Neurodevelopment after Intracranial Haemorrhage due to Fetal and Neonatal Alloimmune Thrombocytopenia. Fetal Diagn Ther 2018; 45:184-191. [PMID: 29730660 DOI: 10.1159/000488280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the perinatal and long-term neurodevelopmental outcome in a cohort of children with intracranial haemorrhage (ICH) due to fetal and neonatal alloimmune thrombocytopenia (FNAIT) and to clearly outline the burden of this disease. SUBJECTS AND METHODS We performed an observational cohort study and included all consecutive cases of ICH caused by FNAIT from 1993 to 2015 at Leiden University Medical Centre. Neurological, motor, and cognitive development were assessed at a minimum age of 1 year. The primary outcome was adverse outcome, defined as perinatal death or severe neurodevelopmental impairment (NDI). Severe NDI was defined as any of the following: cerebral palsy (Gross Motor Function Classification System [GMFCS] level ≥II), bilateral deafness, blindness, or severe motor and/or cognitive developmental delay (<-2 SD). RESULTS In total, 21 cases of ICH due to FNAIT were included in the study. The perinatal mortality rate was 10/21 (48%). Long-term outcome was assessed in 10 children (n = 1 lost to follow-up). Severe and moderate NDI were diagnosed in 6/10 (60%) and 1/10 (10%) of the surviving children. The overall adverse outcome, including perinatal mortality or severe NDI, was 16/20 (80%). CONCLUSIONS The risk of perinatal death or severe NDI in children with ICH due to FNAIT is high. Only screening and effective preventive treatment can avoid this burden.
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Affiliation(s)
- Dian Winkelhorst
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The
| | - Marije M Kamphuis
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monique Rijken
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeanine M M van Klink
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
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