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Oosterhoff JJ, Linty F, Visser R, de Vos T, Hofstede-van Egmond S, van de Weerd M, Porcelijn L, de Haas M, van der Schoot E, Vidarsson G. Generation of human antibodies targeting human platelet antigen (HPA)-1a. Transfusion 2024; 64:893-905. [PMID: 38400657 DOI: 10.1111/trf.17758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a condition during pregnancy, which can lead to thrombocytopenia and a bleeding tendency with intracranial hemorrhage (ICH) being the most concerning complication in the fetus or neonate. An incompatibility between human platelet antigen (HPA)-1a accounts for the majority of FNAIT cases. Binding of HPA-1a-specific alloantibodies to their target on fetal platelets and endothelial cells can induce apoptosis of megakaryocytes, disrupt platelet function, and impair angiogenesis. Currently, there is no screening program to identify pregnancies at risk for severe disease. A better understanding of HPA-1a-specific antibody heterogeneity in FNAIT could aid in identifying pathogenic antibody properties linked to severe disease. STUDY DESIGN AND METHODS This study aimed to isolate HPA-1a-specific B-cells from an HPA-1a-alloimmunized pregnant woman. Using fluorescently labeled HPA-1a-positive platelets, single B-cells were sorted and cultured for 10 days to stimulate antibody production. Subsequently, supernatants were tested for the presence of antibodies by enzyme-linked immunosorbent assay and their reactivity towards HPA-1a-positive platelets. Amplification and sequencing of variable regions allowed the generation of monoclonal antibodies using a HEK-Freestyle-based expression system. RESULTS Three platelet-specific B-cells were obtained and cloned of which two were specific for HPA-1a, named D- and M-204, while the third was specific for HLA class I, which was named L-204. DISCUSSION This study outlined an effective method for the isolation of HPA-1a-specific B-cells and the generation of monoclonal antibodies. Further characterization of these antibodies holds promise for better understanding the pathogenic nature of alloantibodies in FNAIT.
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Affiliation(s)
- Janita J Oosterhoff
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, The Netherlands
| | - Federica Linty
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, The Netherlands
| | - Remco Visser
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, The Netherlands
| | - Thijs de Vos
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Miranda van de Weerd
- Department of Immunogenetics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht University, Utrecht, The Netherlands
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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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de Vos TW, Winkelhorst D, Porcelijn L, Beaufort M, Oldert G, van der Bom JG, Lopriore E, Oepkes D, de Haas M, van der Schoot E. Natural history of human platelet antigen 1a-alloimmunised pregnancies: a prospective observational cohort study. Lancet Haematol 2023; 10:e985-e993. [PMID: 38407610 DOI: 10.1016/s2352-3026(23)00271-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare disease that untreated can lead to intracranial haemorrhage or death. The natural history of FNAIT is still unclear; therefore, the benefits of screening cannot be estimated and no routine screening is yet in place. We aimed to assess the incidence of clinically detectable FNAIT among pregnancies in human platelet antigen-1a (HPA-1a)-immunised women. METHODS We did a prospective observational cohort study of pregnant women negative for rhesus D (RhD) and rhesus c (Rhc) antigens, without age limits, who underwent routine antenatal screening for red cell antibodies at 27 weeks' gestation and were typed for HPA-1a between March 1, 2017, and May 1, 2020. HPA-1a-negative women were tested for HPA alloantibodies. Health-care professionals were masked to all test results. The main outcome was the proportion of neonates with severe, clinically detectable FNAIT, defined as having an intracranial bleed, organ bleed, or bleeding-related death observed during pregnancy or within the first week of life. Cases of clinically detectable FNAIT not categorised as severe were categorised as mild. This study is registered with ClinicalTrials.gov (NCT04067375). FINDINGS Of 153 106 women typed for HPA-1a, 3722 (2·4%) were negative for HPA-1a. 913 HPA-1a-negative women gave informed consent, underwent HPA-1a antibody screening, and were included in the study. Anti-HPA-1a antibodies were detected in 85 HPA-1a-negative participants, among whom three with HPA-1a-negative fetuses and one with a previous child with FNAIT were excluded. As controls, 820 HPA-1a-negative, non-immunised pregnancies and 2704 randomly selected pregnancies of women negative for RhD and Rhc who were typed HPA-1a positive were included. Of 81 fetuses included, one (1·2%) was diagnosed with severe HPA-1a-mediated intracranial haemorrhage and three (3·7%) had mild FNAIT. Gravidity and parity did not seem to be risk factors for HPA-1a immunisation. 73 (90·1%) of 81 HPA-1a-immunised women were positive for HLA-DRB3*01:01. INTERPRETATION Our data suggest that, without intervention, the incidence of major clinically detectable bleeding in FNAIT is estimated as 11 (95% CI 0-32) per 10 000 HPA-1a-negative pregnancies. These findings imply that severe bleeding is a rare event that potentially could be prevented by a screening programme. FUNDING Landsteiner Foundation for Blood Transfusion Research and 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; Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
| | - Dian Winkelhorst
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands; Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Mila Beaufort
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | - Gonda Oldert
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Masja de Haas
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands; Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, Netherlands; Department of Hematology, Leiden University Medical Center, Leiden, Netherlands
| | - Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.
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Zhang N, Sullivan MJ, Curtis BR, Newman PJ. O-linked sialic acid residues on platelet membrane glycoprotein IIb mask the human HPA-9b alloepitope. Blood 2023; 142:1909-1917. [PMID: 37738558 PMCID: PMC10731917 DOI: 10.1182/blood.2023021122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/24/2023] Open
Abstract
Sialic acids occupy the terminal position of glycan chains and have the potential to influence the antigenicity of glycoproteins (GP). The polymorphisms of human platelet alloantigens (HPA)-3 and HPA-9, located near the C-terminus of the extracellular domain of platelet membrane GPIIb, are adjacent to sialyl-core 1 O-glycans emanating from serines 845 and 847. Whether the nearby O-glycans affect the antigenicity of HPA-9b or influence the binding of anti-HPA-9b alloantibodies in clinically significant cases of neonatal alloimmune thrombocytopenia is unknown. To address this issue, we generated a series of O-glycan mutant HPA-9 allele-specific induced pluripotent stem cell lines, differentiated them to megakaryocytes (MKs), and examined their ability to bind HPA-9b-specific alloantibodies. We found that both wild-type MKs treated with neuraminidase and those genetically modified to lack the sialidases ST3GAL1 and ST3GAL2 dramatically increased anti-HPA-9b alloantibody binding, indicating that the HPA-9b epitope is partially masked by terminal sialic acids on nearby O-glycans of GPIIb. Interestingly, mutating the serine residues that carry these glycan chains to alanine actually reduced the binding of anti-HPA-9b alloantibodies, indicating that these 2 O-glycan chains contribute to the presentation of the HPA-9b epitope-perhaps by stabilizing the conformation of the GP in this region. Collectively, our data suggest that detection of anti-HPA-9b alloantibodies may be enhanced through the use of HPA-9b-specific MKs that have been genetically altered to lack nearby terminal sialic acid residues but retain the glycan chains to which they are attached.
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Affiliation(s)
- Nanyan Zhang
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI
| | - Mia J. Sullivan
- Platelet and Neutrophil Immunology Laboratory, Versiti Blood Center of Wisconsin, Milwaukee, WI
| | - Brian R. Curtis
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI
- Platelet and Neutrophil Immunology Laboratory, Versiti Blood Center 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, Medical College of Wisconsin, Milwaukee, WI
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5
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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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6
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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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7
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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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8
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Barg A, Bonstein L. New Horizons in Fetal and Neonatal Alloimmune Thrombocytopenia. Semin Thromb Hemost 2022; 49:402-408. [PMID: 36368687 DOI: 10.1055/s-0042-1757900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractFetal and neonatal alloimmune thrombocytopenia (FNAIT) is a common cause of severe thrombocytopenia in newborns. Intracranial bleeding may lead to severe neurological sequelae and mortality. Current management of pregnancies at risk is suboptimal. Prenatal FNAIT diagnosis commonly requires invasive procedures and therapy is associated with a high treatment burden. The present review explores advances in the field and their potential contribution to modification of the diagnostic and therapeutic landscape. Topics addressed include the role of noninvasive prenatal testing using fetal cell free DNA, insights into novel and prospective therapeutic options achieved through the development of murine models of FNAIT as well as the forecast for the progress in pregnancy risk stratification through advancement in the investigation of biological characteristics of alloantibodies and their association with the risk of fetal bleeding.
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Affiliation(s)
- Assaf Barg
- National Hemophilia Center, Sheba Medical Center, Amalia Biron Research Institute of Thrombosis and Hemostasis, Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Lilach Bonstein
- Blood Bank and Platelet Immunology Laboratories, Rambam Health Care Campus, Haifa, Israel
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9
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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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10
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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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11
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Severe platelet transfusion refractoriness due to anti-HPA-5a antibody during induction chemotherapy for acute promyelocytic leukemia. Ann Hematol 2022; 101:2103-2105. [PMID: 35612605 DOI: 10.1007/s00277-022-04875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/22/2022] [Indexed: 11/01/2022]
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12
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Ernstsen SL, Ahlen MT, Johansen T, Bertelsen EL, Kjeldsen-Kragh J, Tiller H. Antenatal intravenous immunoglobulins in pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia: comparison of neonatal outcome in treated and nontreated pregnancies. Am J Obstet Gynecol 2022; 227:506.e1-506.e12. [PMID: 35500612 DOI: 10.1016/j.ajog.2022.04.044] [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: 12/08/2021] [Revised: 04/01/2022] [Accepted: 04/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Maternal alloantibodies to human platelet antigen-1a can cause severe intracranial hemorrhage in a fetus or newborn. Although never evaluated in placebo-controlled clinical trials, most Western countries use off-label weekly administration of high-dosage intravenous immunoglobulin in all pregnant women with an obstetrical history of fetal and neonatal alloimmune thrombocytopenia. In Norway, antenatal intravenous immunoglobulin is only recommended in pregnancies wherein a previous child had intracranial hemorrhage (high-risk) and is generally not given in other human platelet antigen-1a alloimmunized pregnancies (low-risk). OBJECTIVE To compare the frequency of anti-human platelet antigen-1a-induced intracranial hemorrhage in pregnancies at risk treated with intravenous immunoglobulin vs pregnancies not receiving this treatment as a part of a different management program. STUDY DESIGN This was a retrospective comparative study where the neonatal outcomes of 71 untreated human platelet antigen-1a-alloimmunized pregnancies in Norway during a 20-year period was compared with 403 intravenous-immunoglobulin-treated pregnancies identified through a recent systematic review. We stratified analyses on the basis of whether the mothers belonged to high- or low-risk pregnancies. Therefore, only women who previously had a child with fetal and neonatal alloimmune thrombocytopenia were included. RESULTS Two neonates with brain bleeds were identified from 313 treated low-risk pregnancies (0.6%; 95% confidence interval, 0.2-2.3). There were no neonates born with intracranial hemorrhage of 64 nontreated, low-risk mothers (0.0%; 95% confidence interval, 0.0-5.7). Thus, no significant difference was observed in the neonatal outcome between immunoglobulin-treated and untreated low-risk pregnancies. Among high-risk mothers, 5 of 90 neonates from treated pregnancies were diagnosed with intracranial hemorrhage (5.6%; 95% confidence interval, 2.4-12.4) compared with 2 of 7 neonates from nontreated pregnancies (29%; 95% confidence interval, 8.2-64.1; P=.08). CONCLUSION The most reliable data hitherto for the evaluation of intravenous immunoglobulins treatment in low-risk pregnancies is shown herein. We did not find evidence that omitting antenatal intravenous immunoglobulin treatment in low-risk pregnancies increases the risk of neonatal intracranial hemorrhage.
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13
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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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14
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Jovanovic Srzentic S, Lilic M, Vavic N, Radovic I, Djilas I. Genotyping of Eight Human Platelet Antigen Systems in Serbian Blood Donors: Foundation for Platelet Apheresis Registry. Transfus Med Hemother 2021; 48:228-233. [PMID: 34539316 DOI: 10.1159/000514487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study was to investigate the allele and genotype frequencies of 8 human platelet antigen (HPA) systems among blood donors from the Blood Transfusion Institute of Serbia and to compare them with published studies. These data would be useful to establish the basis for a platelet apheresis donor registry. Material and Methods Seventy-two unrelated male platelet apheresis/blood donors from Serbia were typed for 8 HPA systems (HPA-1 to HPA-6, HPA-9, and HPA-15) via the FluoGene method, based on polymerase chain reaction-sequence-specific amplification (PCR-SSP; PCR using sequence-specific primers) with fluorometric signal detection. Allele and genotype frequencies were estimated by direct counting and compared to the expected genotype frequencies according to the Hardy-Weinberg principle. The transfusion mismatch probability was calculated for every HPA specificity. Results The allele frequencies were: HPA-1a, 0.868; HPA-1b, 0.132; HPA-2a, 0.917; HPA-2b, 0.083; HPA-3a, 0.611; HPA-3b, 0.389; HPA-5a, 0.903; HPA-5b, 0.097; HPA-9a, 0.993; HPA-9b, 0.007; HPA-15a, 0.472; and HPA-15b, 0.528. For HPA-4 and HPA-6 only allele a was detected. Discussion The HPA allele frequencies of European populations showed no significant differences in comparison with our results. Statistically significant differences were revealed in comparison with some populations of non-European origin. In the tested donors no HPA-2 bb genotype was detected, but we found 1 donor with the rare HPA-9b allele. The biggest transfusion mismatch probability in the Serbian population is for systems HPA-15 (37.4%) and HPA-3 (36.2%), which means that more than a third of random transfusions could cause mismatch in these systems. This study was enabled by the introduction of molecular HPA typing, and it provides initial results of the HPA allele and genotype frequencies in the population of blood donors in Serbia. They will be used to provide a compatible blood supply on demand for treating patients with alloimmune thrombocytopenic disorders. The successful implementation of PCR-SSP with fluorometric signal detection could be further complemented in the future by the introduction of high-throughput methods, which will largely depend on the available financial resources.
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Affiliation(s)
- Snezana Jovanovic Srzentic
- Department of Prenatal Molecular Testing and Blood Group Typing, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Marko Lilic
- Department of Biology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Natasa Vavic
- Department of Donor Apheresis, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Ivana Radovic
- Department of Prenatal Molecular Testing and Blood Group Typing, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Iva Djilas
- Department of Blood Donor Testing, Blood Transfusion Institute of Serbia, Belgrade, Serbia
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15
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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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16
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de Vos TW, Porcelijn L, Hofstede-van Egmond S, Pajkrt E, Oepkes D, Lopriore E, van der Schoot CE, Winkelhorst D, de Haas M. Clinical characteristics of human platelet antigen (HPA)-1a and HPA-5b alloimmunised pregnancies and the association between platelet HPA-5b antibodies and symptomatic fetal neonatal alloimmune thrombocytopenia. Br J Haematol 2021; 195:595-603. [PMID: 34402048 PMCID: PMC9291578 DOI: 10.1111/bjh.17731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Fetal neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal alloantibodies directed against the human platelet antigens (mostly HPA-1a or HPA-5b) of the (unborn) child and can lead to severe bleeding. Anti-HPA-1a-mediated FNAIT shows a severe clinical outcome more often than anti-HPA-5b-mediated FNAIT. Given the relatively high prevalence of anti-HPA-5b in pregnant women, the detection of anti-HPA-5b in FNAIT-suspected cases may in some cases be an incidental finding. Therefore we investigated the frequency of anti-HPA-5b-associated severe bleeding in FNAIT. We performed a retrospective nationwide cohort study in cases with clinical suspicion of FNAIT. HPA antibody screening was performed using monoclonal antibody-specific immobilisation of platelet antigens. Parents and neonates were typed for the cognate antigen. Clinical data were collected by a structured questionnaire. In 1 864 suspected FNAIT cases, 161 cases (8·6%) had anti-HPA-1a and 60 (3·2%) had anti-HPA-5b. The proportion of cases with severe bleeding did not differ between the cases with anti-HPA-1a (14/129; 11%) and anti-HPA-5b (4/40; 10%). In multigravida pregnant women with a FNAIT-suspected child, 100% (81/81) of anti-HPA-1a cases and 79% (38/48) of anti-HPA-5b cases were HPA-incompatible, whereas 86% and 52% respectively were expected, based on the HPA allele distribution. We conclude that anti-HPA-5b can be associated with severe neonatal bleeding symptoms. A prospective study is needed for true assessment of the natural history of anti-HPA-5b mediated FNAIT.
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Affiliation(s)
- Thijs W de Vos
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Centre, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands
| | | | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Dian Winkelhorst
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Experimental Immunohematology, Sanquin, Amsterdam, the Netherlands
| | - Masja de Haas
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Hematology, Leiden University Medical Centre, Leiden, the Netherlands
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17
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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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18
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Sharp G, Poles A, Studholme L. A first WHO reference reagent for the detection of anti-human platelet antigen-15b. Vox Sang 2021; 117:275-281. [PMID: 34164825 PMCID: PMC9292896 DOI: 10.1111/vox.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
Background and Objectives Alloantibodies to human platelet antigen‐15b (anti‐HPA‐15b) have been detected in mothers with foetal–neonatal alloimmune thrombocytopenia and in multiply transfused patients. Assays used to detect this antibody, which aids in disease diagnosis, can be unreliable and vary in sensitivity. The objective was to generate a stable, lyophilized anti‐HPA‐15b preparation and evaluate its suitability as a World Health Organization (WHO) reference reagent for use in the quality control of platelet alloantibody detection assays. Results from an international collaborative study to evaluate the preparation were used to assign a minimum potency at which laboratories can be expected to detect the antibody. Materials and Methods Recalcified plasma containing anti‐HPA‐15b was aliquotted, lyophilized and coded 18/220. Twenty‐five laboratories in 16 countries tested doubling dilutions of the reconstituted material in glycoprotein‐specific assays such as the monoclonal antibody–specific immobilization of platelet antigen assay and reported the last positive (or endpoint) dilution. Results Twenty‐four laboratories (96%) detected antibodies with HPA‐15b specificity in preparation 18/220. Reported endpoint dilutions were normally distributed with a modal dilution of 1 in 16 and ranged from 1 in 2 to 1 in 128. Only two laboratories (8%) failed to detect anti‐HPA‐15b at 1 in 8 dilution. Conclusions When diluted 1 in 8, most laboratories detected anti‐HPA‐15b in preparation 18/220 using HPA‐15bb platelets but not with HPA‐15aa platelets. The participants agreed this to be an appropriate dilution for assignment as the minimum potency. In October 2020, the WHO Expert Committee on Biological Standardization approved 18/220 as an International Reference Reagent.
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Affiliation(s)
- Giles Sharp
- Biotherapeutics Division, National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK
| | - Anthony Poles
- Histocompatibility and Immunogenetics, NHSBT, Filton, UK
| | - Lucy Studholme
- Biotherapeutics Division, National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK
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19
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Kinney S. Pediatric Transfusion Medicine. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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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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21
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Flesch BK, Scherer V, Opitz A, Ochmann O, Janson A, Steitz M, Zeiler T. Platelet CD36 deficiency is present in 2.6% of Arabian individuals and can cause NAIT and platelet refractoriness. Transfusion 2021; 61:1932-1942. [PMID: 33822386 DOI: 10.1111/trf.16398] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND CD36 isoantibodies are capable of inducing neonatal alloimmune thrombocytopenia (NAIT) and platelet refractoriness. As to now the CD36 type I deficiency has been reported in East Asian and African individuals. However, it is virtually unknown in Caucasians. The aim of this study was to display the prevalence of the CD36 deficiency within parts of the Arabian population in Germany. Secondly, we are presenting the case of a newborn suffering from NAIT which was induced by CD36 antibody. METHODS Platelet (p) CD36 was determined by flow cytometry on 1328 samples mainly from individuals of Arabian origin and a family with a neonate affected by NAIT. DNA sequencing was performed on all pCD36-negative samples. RESULTS Thirty-five (2.64%) of all donor samples were pCD36 negative, 19 (1.43%) had a weak expression. Including only individuals from the Arabian peninsula, frequencies were 3.39% and 1.75%, respectively. CD36 type I deficiency on both platelets and monocytes combined with a CD36 isoantibody were detected in the mother of the NAIT baby. The baby was successfully transfused with two HPA-unselected platelet concentrates. In case of need, two platelet units with a weak pCD36 expression were on hand. A total of 45 different CD36 mutations were detected within pCD36-negative individuals, some being homozygous, most of them only present on one allele. CONCLUSION The CD36-negative phenotype is present in a significant number of individuals of Arabian origin and enables CD36 isoimmunization in NAIT or refractoriness. Blood transfusion services should be aware of such cases.
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Affiliation(s)
- Brigitte K Flesch
- German Red Cross Blood Service Rhineland-Palatinate and Saarland, Bad Kreuznach, Germany.,German Red Cross Blood Service West, Hagen, Germany
| | - Vanessa Scherer
- German Red Cross Blood Service Rhineland-Palatinate and Saarland, Bad Kreuznach, Germany
| | - Andreas Opitz
- German Red Cross Blood Service Rhineland-Palatinate and Saarland, Bad Kreuznach, Germany
| | - Oswin Ochmann
- German Red Cross Blood Service Rhineland-Palatinate and Saarland, Bad Kreuznach, Germany
| | - Anne Janson
- German Red Cross Blood Service Rhineland-Palatinate and Saarland, Bad Kreuznach, Germany
| | - Monika Steitz
- German Red Cross Blood Service Rhineland-Palatinate and Saarland, Bad Kreuznach, Germany
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22
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Norrenbrock S, Müller TH, Mayer C, Doescher A. A nait-associated and previously unreported mutation in the ITGB3 gene with a low frequency in the local population. Transfus Med 2021; 31:286-291. [PMID: 33724573 DOI: 10.1111/tme.12769] [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: 12/01/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neonatal alloimmune thrombocytopenia is a rare but potentially severe postnatal complication caused by maternal allo-antibodies against platelet antigens of the newborn. In relatively few cases, immunisation against low-frequency antigens has been reported. METHODS Platelet antigens of a newborn with severe thrombocytopenia and his family members were investigated by serological and molecular biological methods. A real-time PCR assay was developed to reliably detect this mutation in pools of DNA from up to seven individuals. RESULTS Serological testing showed positive reactions of maternal plasma with paternal platelets but not with conventional platelet donor panels. Sequencing of the ITGB3 gene revealed a G > A polymorphism in position c.1915 of exon 12 for the father, the newborn and three of four paternal relatives. Screening of samples from a local population of 1575 Caucasian blood donors identified only a single individual with this mutation. CONCLUSION This finding of a previously unreported private platelet antigen demonstrates that the identification of the target glycoprotein by MAIPA assay followed by sequencing of the affected gene can be combined with an efficient population screening by real-time PCR with pooling of DNA samples.
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Affiliation(s)
- Stefan Norrenbrock
- DRK-Blutspendedienst NSTOB, Institut Bremen-Oldenburg, Oldenburg, Germany
| | - Thomas H Müller
- DRK-Blutspendedienst NSTOB, Institut Springe, Springe, Germany
| | | | - Andrea Doescher
- DRK-Blutspendedienst NSTOB, Institut Bremen-Oldenburg, Oldenburg, Germany
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23
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Stubbs J, Klompas A, Thalji L. Transfusion Therapy in Specific Clinical Situations. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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24
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Murakhovskaya I, Demasio KA. Maternal Hematologic Conditions and Fetal/Neonatal Outcomes of Pregnancy. Neoreviews 2021; 22:e95-e103. [PMID: 33526639 DOI: 10.1542/neo.22-2-e95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hematologic conditions in reproductive-age women can complicate pregnancy and the neonatal period. Affected pregnancies have a higher risk of severe morbidity and mortality. Coagulation factor changes that occur in the normal state of pregnancy can delay detection and recognition of a bleeding disorder in cases without an apparent bleeding history, thus hindering the appropriate management during gestation and the neonatal period. In addition, unique maternal immunologic changes occur during pregnancy, which are meant to protect the fetus who shares paternal antigens. Rarely, derangement of the maternal immune system may result in alloimmunization against fetal platelet antigens, leading to the development of fetal and/or neonatal thrombocytopenia. Bleeding and platelet disorders pose significant risk of intracranial hemorrhage for the fetus and newborn that is associated with significant morbidity and mortality. We discuss contemporary diagnosis and management of rare bleeding and platelet disorders in pregnancy and their effect on the neonatal period.
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Affiliation(s)
- Irina Murakhovskaya
- Department of Hematology and Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Kafui A Demasio
- Department of Obstetrics and Gynecology, Maternal and Fetal Medicine, St Johns Riverside Hospital, Yonkers, NY
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Zerra PE, Josephson CD. Transfusion in Neonatal Patients: Review of Evidence-Based Guidelines. Clin Lab Med 2020; 41:15-34. [PMID: 33494882 DOI: 10.1016/j.cll.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transfusion of red blood cells, platelets, and fresh frozen plasma in neonatal patients has not been well characterized in the literature, with guidelines varying greatly between institutions. However, anemia and thrombocytopenia are highly prevalent, especially in preterm neonates. When transfusing a neonatal patient, clinicians must take into consideration physiologic differences, gestational and postnatal age, congenital disorders, and maternal factors while weighing the risks and benefits of transfusion. This review of existing literature summarizes current evidence-based neonatal transfusion guidelines and highlights areas of current ongoing research and those in need of future studies.
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Affiliation(s)
- Patricia E Zerra
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA
| | - Cassandra D Josephson
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA.
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Abstract
Platelets, small anucleate cells circulating in the blood, are critical mediators in haemostasis and thrombosis. Interestingly, recent studies demonstrated that platelets contain both pro-inflammatory and anti-inflammatory molecules, equipping platelets with immunoregulatory function in both innate and adaptive immunity. In the context of infectious diseases, platelets are involved in early detection of invading microorganisms and are actively recruited to sites of infection. Platelets exert their effects on microbial pathogens either by direct binding to eliminate or restrict dissemination, or by shaping the subsequent host immune response. Reciprocally, many invading microbial pathogens can directly or indirectly target host platelets, altering platelet count or/and function. In addition, microbial pathogens can impact the host auto- and alloimmune responses to platelet antigens in several immune-mediated diseases, such as immune thrombocytopenia, and fetal and neonatal alloimmune thrombocytopenia. In this review, we discuss the mechanisms that contribute to the bidirectional interactions between platelets and various microbial pathogens, and how these interactions hold relevant implications in the pathogenesis of many infectious diseases. The knowledge obtained from "well-studied" microbes may also help us understand the pathogenesis of emerging microbes, such as SARS-CoV-2 coronavirus.
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Affiliation(s)
- Conglei Li
- Department of Immunology, University of Toronto, Toronto, ON, Canada
- Toronto Platelet Immunobiology Group, University of Toronto, Toronto, ON, Canada
| | - June Li
- Toronto Platelet Immunobiology Group, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Canadian Blood Services Centre for Innovation, Toronto, ON, Canada
| | - Heyu Ni
- Toronto Platelet Immunobiology Group, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Canadian Blood Services Centre for Innovation, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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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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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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Sachs UJ, Wienzek‐Lischka S, Duong Y, Qiu D, Hinrichs W, Cooper N, Santoso S, Bayat B, Bein G. Maternal antibodies against paternal class I human leukocyte antigens are not associated with foetal and neonatal alloimmune thrombocytopenia. Br J Haematol 2020; 189:751-759. [DOI: 10.1111/bjh.16419] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/01/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Ulrich J. Sachs
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
| | - Sandra Wienzek‐Lischka
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
| | - Yalin Duong
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
| | - Dan Qiu
- Institute for Medical Informatics Justus‐Liebig‐University Giessen Germany
| | | | - Nina Cooper
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
| | - Behnaz Bayat
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine Justus‐Liebig‐University Giessen Germany
- German Center for Fetomaternal Incompatibility Giessen Germany
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30
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Abstract
Human platelet antibody (HPA) detection is necessary for the diagnosis and therapeutic decisions for refractoriness to platelet transfusions, post transfusion purpura and fetal and neonatal alloimmune thrombocytopenia. In the last four to five decades many new developments, both in knowledge and methods, have increased the quality of platelet serology. However, the quest for the optimal antibody detection method(s) encountered, sometimes unexpected, difficulties. In this review the various aspects concerning platelet antibody test methods and detection of platelet antibodies both for the diagnostic and screening setting are discussed.
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Affiliation(s)
- L Porcelijn
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands.
| | - E Huiskes
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands
| | - M de Haas
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
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31
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Abstract
Maternal alloimmunization to paternally inherited antigens on fetal/neonatal platelets can cause fetal/neonatal alloimmune thrombocytopenia (FNAIT) after antibody-mediated removal of platelets from the fetal circulation. The complications vary from mild bleeding symptoms to severe intracranial hemorrhage and subsequent neurological impairment or death. Studies on in vivo mechanisms are challenging to measure directly in pregnant women, rendering murine models as valuable and attractive alternatives, despite some critical differences between mice and men affecting the translational value. Here we present and discuss, the different murine models that substantially have increased our knowledge and understanding of FNAIT pathogenesis - as well as pre-clinical evaluation of therapeutic and preventive strategies.
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Affiliation(s)
- Trude Victoria Rasmussen
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway; Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maria Therese Ahlen
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway.
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32
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Abstract
Non-invasive fetal HPA-1a typing is a valuable tool to identify the pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia (FNAIT). At present, prenatal determination of the fetus HPA-1a type is performed for diagnostic purposes in pregnancies of HPA-1 alloimmunized women with history of a previous fetus or child with FNAIT. Different approaches have been used to determine the fetal HPA-1a genotype from cell-free fetal DNA (cffDNA) in the mother's plasma, mainly based on real-time PCR. Due to the single nucleotide polymorphism (SNP) between the HPA-1a and HPA-1b allelic sequences, a robust and accurate detection of the fetal genotype is challenging, and the sensitivity of most assays is still limited early in pregnancy. Nowadays, the availability of technologies such as next generation sequencing (NGS) or digital PCR offers unprecedented possibilities of analyzing cell-free DNA (cfDNA)-amplified sequences with very high coverage and high sensitivity. In addition, other interesting approaches using variant sequence enrichment strategies have been recently described. In particular, coamplification at lower denaturation temperature PCR (COLD-PCR) offers a simple and sensitive strategy for noninvasive fetal HPA-1 typing. These novel approaches are explained in more detail in this review. Despite no population-based FNAIT screening programs have so far been implemented, the perspectives in terms of treatment and prevention are changing and less costly high-throughput maternal HPA-1a typing methods have been developed. Altogether, this may lead to the implementation of fetal HPA-1a typing with a broader scope in the future, playing a critical role within FNAIT screening programs.
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Affiliation(s)
- Núria Nogués
- Immunohematology Laboratory, Banc de Sang i Teixits, Pg. Taulat 116, 08005 Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 129-139, 08035 Barcelona, Spain.
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33
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Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease in pregnancy characterized by maternal alloantibodies directed against the human platelet antigen (HPA). These antibodies can cause intracranial hemorrhage (ICH) or other major bleeding resulting in lifelong handicaps or death. Optimal fetal care can be provided by timely identification of pregnancies at risk. However, this can only be done by routinely antenatal screening. Whether nationwide screening is cost-effective is still being debated. HPA-1a alloantibodies are estimated to be found in 1 in 400 pregnancies resulting in severe burden and fetal ICH in 1 in 10.000 pregnancies. Antenatal treatment is focused on the prevention of fetal ICH and consists of weekly maternal IVIg administration. In high-risk FNAIT treatment should be initiated at 12-18 weeks gestational age using high dosage and in standard-risk FNAIT at 20-28 weeks gestational age using a lower dosage. Postnatal prophylactic platelet transfusions are often given in case of severe thrombocytopenia to prevent bleedings. The optimal threshold and product for postnatal transfusion is not known and international consensus is lacking. In this review practical guidelines for antenatal and postnatal management are offered to clinicians that face the challenge of reducing the risk of bleeding in fetuses and infants affected by FNAIT.
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Winkelhorst D, Porcelijn L, Muizelaar E, Oldert G, Huiskes E, van der Schoot CE. Fast and low-cost direct ELISA for high-throughput serological HPA-1a typing. Transfusion 2019; 59:2989-2996. [PMID: 31329320 DOI: 10.1111/trf.15454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal alloantibodies against fetal human platelet antigens (HPAs), mostly caused by anti-HPA-1a. Population-based screening for FNAIT is still a topic of debate. Logistically and financially, the major challenge for implementation is the typing of pregnant women to recognize the 2% HPA-1a-negative women. Therefore, there is need for a high-throughput and low-cost HPA-1a-typing assay. STUDY DESIGN AND METHODS A sandwich ELISA was developed, using a monoclonal anti-GPIIIa as coating antibody and horseradish-peroxidase-conjugated recombinant anti-HPA-1a, as detecting antibody. The ELISA results were compared to an allelic discrimination PCR-assay. In phase I, samples from unselected consecutive pregnant women were tested with both assays. Phase II was part of a prospective screening study in pregnancy and genotyping was restricted to samples with an arbitrary set, OD < 0.500. RESULTS The ELISA was optimized to require no additional handling (swirling or spinning) of stored tubes. During phase I, 506 samples were tested. In phase II, another 62,171 consecutive samples were phenotyped, with supportive genotyping in 1,902. In total 1,585 HPA-1a negative and 823 HPA-1a positive women were genotyped. The assay reached 100% sensitivity with a cut-off OD from 0.160, corresponding with a 99.9% specificity and a false-HPA-1a negative rate of 0.03. CONCLUSION A high-throughput, low-cost, and reliable HPA-1a phenotyping assay was developed which can be used in population-based screening to select samples for testing of presence of anti-HPA-1a. Because plasma from tubes of 3- to 6-days-old samples can be used, this assay is applicable to settings with suboptimal conditions.
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Affiliation(s)
- Dian Winkelhorst
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Experimental Immunohematology, Sanquin, Amsterdam, The Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
| | - Eva Muizelaar
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
| | - Gonda Oldert
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
| | - Elly Huiskes
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, The Netherlands
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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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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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Venkatesh HA, Paul A, Kantharaj A, Chandrashekar S. A case report of neonatal alloimmune thrombocytopenia: The utility of platelet crossmatch studies in the diagnosis and management. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_50_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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40
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Silva-Malta MCF, de Oliveira LGT, Barreiros LF, do Amaral DR, Martins ML. Human Platelet Antigens in Brazilian Multiethnic Populations: Occurrence of Regional Variation and Frequency in a Large Urban Center (Belo Horizonte). Transfus Med Hemother 2018; 45:388-396. [PMID: 30574056 DOI: 10.1159/000488469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/15/2018] [Indexed: 11/19/2022] Open
Abstract
Background The frequency of human platelet antigens (HPA) varies according to ethnicity, which causes differences in the morbidity of alloimmune and autoimmune thrombocytopenic disorders in different populations. Studies on HPA frequencies in Brazil have reported differences among Brazilian populations produced by the diverse degrees of admixture throughout the country. Methods In the present study, we investigated the variation of HPA distribution in Brazil, compared with worldwide populations, and describe the frequencies of HPA-1, -2, -3, -5, and -15 in a large urban center in Southern Brazil (Belo Horizonte) based on a sample of blood donors. Results The principal component analysis and the dendrogram based on genetic distance revealed a clear relationship between Brazilian populations and the groups formed by European and African populations. The coefficients of variation for HPA allele frequencies suggest that Brazilian populations presented variations for HPA alleles comparable with the populations from continental groups. In Belo Horizonte, the allele a frequencies for HPA-1, -2, -3, -5 and -15 were 0.8575, 0.8400, 0.6225, 0.8525 and 0.5825 respectively. The genotypes with higher frequencies were a/a (72-74%), except for HPA-3 and -15, whose heterozygous a/b genotypes were shown to be more prevalent (43.5 and 44.5%, respectively). Conclusion We confirmed the heterogeneity of HPA antigens in Brazilian populations, reinforcing the importance of HPA panels composed of regional blood donors, or a national panel that contemplates the specificities of the different regions of the country, in order to provide support in platelet transfusions and to minimize the risks associated with HPA alloimmunization. The evaluation of HPA data from Belo Horizonte represents the initial step toward the development of a genotyped platelet donor registry in order to treat HPA alloimmunized patients in this region.
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Affiliation(s)
| | | | - Luísa Ferreira Barreiros
- Serviço de Pesquisa, Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Fundação Hemominas, Belo Horizonte, Brazil
| | - Dilson Rocha do Amaral
- Setor de Aférese, Hemocentro de Belo Horizonte, Fundação Hemominas, Belo Horizonte, Brazil
| | - Marina Lobato Martins
- Serviço de Pesquisa, Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Fundação Hemominas, Belo Horizonte, Brazil
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Tomiyama Y. ANTI-PLATELET ANTIBODIES (ALLO-, ISO-, OR AUTO-ANTIBODIES) AND THEIR CLINICAL RELEVANCE. ACTA ACUST UNITED AC 2018. [DOI: 10.3925/jjtc.64.681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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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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Samelson-Jones BJ, Kramer PM, Chicka M, Gunning WT, Lambert MP. MYH9-macrothrombocytopenia caused by a novel variant (E1421K) initially presenting as apparent neonatal alloimmune thrombocytopenia. Pediatr Blood Cancer 2018; 65. [PMID: 29286575 DOI: 10.1002/pbc.26949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 01/19/2023]
Abstract
MYH9-related disease is a rare cause of thrombocytopenia. We report an infant girl who presented with severe thrombocytopenia at birth and was initially diagnosed with and treated for neonatal alloimmune thrombocytopenia. However, persistent thrombocytopenia led to the suspicion of congenital thrombocytopenia and subsequent identification of a novel variant in MYH9 (E1421K). In silico analysis strongly predicts that this is a disruptive substitution. Immunofluorescent analysis of neutrophils demonstrates abnormal aggregates of MYH9 protein. This case also suggests that a very high immature platelet fraction (≥40%) may be useful for rapidly differentiating MYH9-related disease from other causes of neonatal thrombocytopenia.
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Affiliation(s)
- Benjamin J Samelson-Jones
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paula M Kramer
- Department of Pathology, The University of Toledo, Toledo, Ohio
| | | | | | - Michele P Lambert
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
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45
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Moncharmont P. Platelet component transfusion and alloimmunization: Where do we stand? Transfus Clin Biol 2018; 25:172-178. [PMID: 29478960 DOI: 10.1016/j.tracli.2018.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Abstract
Platelet transfusion in patients, particularly in onco-haematology, is frequent and can become chronic in some cases. Post-transfusion alloimmunization is often seen, in practice. The risk of this is significantly improved in multitransfused patients. Several classes of antigens binding on platelets (HLA and HPA) are involved and also red blood cell antigens (residual red blood cells in platelet concentrates). Platelet alloimmunization causes a poor transfusion response, refractoriness and, more rarely, post-transfusion purpura. In an alloimmunized recipient, the efficiency of platelet transfusion is based on the selection of compatible products. Significant technical progress means that several methods are currently available to ensure a good post-transfusion platelet count and a satisfactory clinical outcome for the patient.
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Affiliation(s)
- P Moncharmont
- Hémovigilance, département des vigilances, site de Décines, Établissement français du sang Auvergne-Rhône-Alpes, 111, rue Élisée-Reclus CS 20617, 69153 Décines-Charpieu cedex, France.
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46
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Pediatric Transfusion Medicine. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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47
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Refsum E, Håkansson S, Mörtberg A, Wikman A, Westgren M. Intracranial hemorrhages in neonates born from 32 weeks of gestation-low frequency of associated fetal and neonatal alloimmune thrombocytopenia: a register-based study. Transfusion 2017; 58:223-231. [DOI: 10.1111/trf.14394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Erle Refsum
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
| | - Stellan Håkansson
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - Anette Mörtberg
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Agneta Wikman
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
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Jallu V, Beranger T, Bianchi F, Casale C, Chenet C, Ferre N, Philippe S, Quesne J, Martageix C, Petermann R. Cab4b, the first human platelet antigen carried by glycoprotein IX discovered in a context of severe neonatal thrombocytopenia. J Thromb Haemost 2017; 15:1646-1654. [PMID: 28561420 DOI: 10.1111/jth.13744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Indexed: 11/28/2022]
Abstract
Essentials Life-threatening maternofetal thrombocytopenias mostly depend on αIIb β3 antigens. We performed serological, genomic and in vitro studies of two life-threatening thrombocytopenias. Identification of a c.368C>T variation leading to Pro123Leu substitution in GPIX. A rare GPIX variant reported in a genomic database define a new alloantigen. SUMMARY Background After three miscarriages, a 39-year-old woman gave birth, with a 1-year interval, to two severely thrombocytopenic neonates (4 ×109 L-1 and 33 ×109 L-1 ) with intracranial hemorrhages. Transfusion of platelet concentrates corrected the thrombocytopenia. The outcome was favorable for the first child, but the second one died 10 days after cesarean delivery (31 weeks of gestation + 6 days). Methods Serologic studies were performed with mAb-specific immobilization of platelet antigens and flow cytometry techniques. Human platelet alloantigen (HPA) genotyping was performed with the BioArray HPA BeadChip and PCR-sequence-specific primer techniques. Genomic DNA was studied by direct sequencing of PCR products. The mutant glycoprotein (GP) was expressed in transiently transfected HEK293 cells. Results In MAIPA assay, the maternal serum faintly reacted with GPIbIX from paternal and child 1 platelets, but not with maternal or panel platelets. No maternofetal incompatibility was found in the 22 known HPA systems, tested except for HPA-1b in child 2. A new alloantigen carried by GPIbIX was suspected. Genomic sequencing revealed a paternal GPIX variation (NM_000174.4:c.368C>T). The father and children were heterozygous and incompatible with the mother, who was NM_000174.4:c.368C homozygous. The maternal serum reacted with the GPIX NP_000165.1:p.Leu123 form coexpressed with GPIb in transfected HEK293 cells. The NM_000174.4:c.368T allele (rs202229101) has a minor allele frequency of 0.0002, and was not detected in 120 French subjects (families with fetal and neonatal alloimmune thrombocytopenia [FNAIT]), suggesting that it is rarely implicated in alloimmunization. Conclusion The NP_000165.1:p.Leu123 allele named Cab4b is the first platelet alloantigen described on GPIX. In the absence of other known maternofetal incompatibility, the child 1 case suggests that anti-Cab4b alloantibodies can induce severe thrombocytopenias.
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Affiliation(s)
- V Jallu
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - T Beranger
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - F Bianchi
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - C Casale
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - C Chenet
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - N Ferre
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - S Philippe
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - J Quesne
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - C Martageix
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - R Petermann
- Département d'Immunologie Plaquettaire, Institut National de la Transfusion Sanguine (INTS), Paris, France
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Barg AA, Ifrah AD, Strauss T, Simchen MJ, Orvieto R, Rosenberg N, Kenet G. A man-made disease: Fetal neonatal alloimmune thrombocytopenia due to incompatibility between oocyte donor and gestational mother. Pediatr Blood Cancer 2017; 64. [PMID: 28097780 DOI: 10.1002/pbc.26447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/08/2022]
Abstract
The incompatibility causing fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from a fetus inheriting a paternal human platelet antigen (HPA), which is different from the maternal HPA. We present a unique case of FNAIT in a pregnancy involving an oocyte recipient mother with Turner syndrome. This is the first report of FNAIT in which the suggested mechanism involves antibodies produced by a gestational mother against the incompatible HPA of the oocyte donor.
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Affiliation(s)
- Assaf Arie Barg
- Thrombosis Institute and National Hemophilia Center, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviya Dvir Ifrah
- Thrombosis Institute and National Hemophilia Center, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzipi Strauss
- Department of Neonatology, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal J Simchen
- Department of Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Department of Obstetrics & Gynecology, Infertility & IVF Unit, Sheba Medical Center at Tel Hashomer, Tel Aviv, Israel
| | - Nurit Rosenberg
- Thrombosis Institute and National Hemophilia Center, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kenet
- Thrombosis Institute and National Hemophilia Center, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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50
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Penel-Page M, Meunier S, Fretigny M, Le Quellec S, Boisseau P, Vinciguerra C, Ternisien C, Rugeri L. Differential diagnosis of neonatal alloimmune thrombocytopenia: Type 2B von Willebrand disease. Platelets 2017; 28:825-828. [DOI: 10.1080/09537104.2017.1293811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mathilde Penel-Page
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Meunier
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Mathilde Fretigny
- Laboratoire de biologie moléculaire, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | - Sandra Le Quellec
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Pierre Boisseau
- Laboratoire de Génétique Médicale, CHU Hôtel Dieu, Nantes, France
| | - Christine Vinciguerra
- Laboratoire de biologie moléculaire, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Lucia Rugeri
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
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