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Hadjiyannis Y, Jones JM, Chibisov I, Kiss J, Gabert K, Sevcik J, Bakdash S, Binstock A, Kilonsky C, Parviainen K, Kaplan A. Successful management of maternal anti-PP1P k alloimmunization in pregnancy with therapeutic plasma exchange and intravenous immunoglobulin. J Clin Apher 2024; 39:e22120. [PMID: 38733134 DOI: 10.1002/jca.22120] [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: 01/03/2024] [Revised: 03/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
Anti-PP1PK alloimmunization is rare given ubiquitous P1PK expression. Prevention of recurrent miscarriages and hemolytic disease of the fetus and newborn (HDFN) in pregnant individuals with anti-PP1PK antibodies has relied upon individual reports. Here, we demonstrate the successful management of maternal anti-PP1PK alloimmunization in a 23-year-old, G2P0010, with therapeutic plasma exchange (TPE), intravenous immunoglobulin (IVIG), and monitoring of anti-PP1Pk titers. Twice-weekly TPE (1.5 plasma volume [PV], 5% albumin replacement) with weekly titers and IVIG (1 g/kg) was initiated at 9 weeks of gestation (WG). The threshold titer was ≥16. Weekly middle cerebral artery-peak systolic velocities (MCA-PSV) for fetal anemia monitoring was initiated at 16 WG. PVs were adjusted throughout pregnancy based on treatment schedule, titers, and available albumin. Antigen-negative, ABO-compatible RBCs were obtained through the rare donor program and directed donation. An autologous blood autotransfusion system was reserved for delivery. Titers decreased from 128 to 8 by 10 WG. MCA-PSV remained stable. At 24 WG, TPE decreased to once weekly. After titers increased to 32, twice-weekly TPE resumed at 27 WG. Induction of labor was scheduled at 38 WG. Vaginal delivery of a 2950 g neonate (APGAR score: 9, 9) occurred without complication (Cord blood: 1+ IgG DAT; Anti-PP1Pk eluted). Newborn hemoglobin and bilirubin were unremarkable. Discharge occurred postpartum day 2. Anti-PP1Pk alloimmunization is rare but associated with recurrent miscarriages and HDFN. With multidisciplinary care, a successful pregnancy is possible with IVIG and TPE adjusted to PV and titers. We also propose a patient registry and comprehensive management plan.
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Affiliation(s)
- Yannis Hadjiyannis
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer M Jones
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Irina Chibisov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Transfusion, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
- Clinical Aphersis, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Joseph Kiss
- Transfusion, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
- Clinical Aphersis, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kim Gabert
- Transfusion, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Joan Sevcik
- Clinical Aphersis, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Suzanne Bakdash
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Transfusion, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
- Clinical Aphersis, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Anna Binstock
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carolyn Kilonsky
- Clinical Aphersis, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
| | - Kristiina Parviainen
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alesia Kaplan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Transfusion, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
- Clinical Aphersis, Vitalant, Northeast Division, Pittsburgh, Pennsylvania, USA
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2
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Jáñez Pedrayes A, Rymen D, Ghesquière B, Witters P. Glycosphingolipids in congenital disorders of glycosylation (CDG). Mol Genet Metab 2024; 142:108434. [PMID: 38489976 DOI: 10.1016/j.ymgme.2024.108434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
Congenital disorders of glycosylation (CDG) are a large family of rare disorders affecting the different glycosylation pathways. Defective glycosylation can affect any organ, with varying symptoms among the different CDG. Even between individuals with the same CDG there is quite variable severity. Associating specific symptoms to deficiencies of certain glycoproteins or glycolipids is thus a challenging task. In this review, we focus on the glycosphingolipid (GSL) synthesis pathway, which is still rather unexplored in the context of CDG, and outline the functions of the main GSLs, including gangliosides, and their role in the central nervous system. We provide an overview of GSL studies that have been performed in CDG and show that abnormal GSL levels are not only observed in CDG directly affecting GSL synthesis, but also in better known CDG, such as PMM2-CDG. We highlight the importance of studying GSLs in CDG in order to better understand the pathophysiology of these disorders.
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Affiliation(s)
- Andrea Jáñez Pedrayes
- Laboratory of Applied Mass Spectrometry, Department of Cellular and Molecular Medicine, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; Metabolomics Expertise Center, Center for Cancer Biology VIB, 3000 Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, 3000 Leuven, Belgium.
| | - Daisy Rymen
- Center for Metabolic Diseases, Department of Paediatrics, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Bart Ghesquière
- Laboratory of Applied Mass Spectrometry, Department of Cellular and Molecular Medicine, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; Metabolomics Expertise Center, Center for Cancer Biology VIB, 3000 Leuven, Belgium.
| | - Peter Witters
- Department of Development and Regeneration, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; Center for Metabolic Diseases, Department of Paediatrics, University Hospitals Leuven, 3000 Leuven, Belgium.
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3
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Bonmatí-Santané A, Céspedes López R, Alvarez Saltos JJ, Calabia Martínez J, Noboa Paez C, Piedra Sánchez J, Visa Figueredo N, Maroto González A. Managing a Pregnancy in the Presence of the Rare Blood Group Antibody PP1Pk. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:319-323. [PMID: 38596479 PMCID: PMC11002322 DOI: 10.1089/whr.2023.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 04/11/2024]
Abstract
Pregnant women with p phenotype, who lack antigens P, P1, and Pk, spontaneously form anti-PP1Pk antibodies whose primary target is the placenta. The risk of miscarriage in these women is 50%-70% and reaches 87% in the second trimester. The therapies aim to reduce the titer of antibodies early in pregnancy. They also have risk of hemolytic transfusion reaction, with very few compatible red blood cell donors in the world. In this study, we present a case of successful pregnancy managed with autologous blood donations and plasmapheresis.
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Affiliation(s)
| | | | | | | | - Cristina Noboa Paez
- Nephrorolgy Service; Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
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4
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Pignalosa O, Vigorita E, Capuano M, Caruso S, Mastroianni A, De Martino S, Vaccaro G, Meomartini D, Nocera C. Treatment with plasma exchange of a pregnant woman with anti-PP1Pk alloimmunization: A case report. Transfus Apher Sci 2024; 63:103871. [PMID: 38245405 DOI: 10.1016/j.transci.2024.103871] [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: 10/12/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/22/2024]
Abstract
The histo-blood group antigens P, P1 and Pk are a closely related set of glycosphingolipid structures expressed by red blood cells and other tissues. None of these three characters is expressed on p cells, a null phenotype that arises in the context of homozygous mutation of the A4GALT gene. Subjects with p phenotype spontaneously develop a natural alloantibody named anti-PP1Pk, which is a mixture of IgG and IgM against P1, P and Pk. While anti-P1 is a weak cold antibody with poor clinical significance, anti-P and anti-Pk antibodies are potent haemolysins responsible for severe hemolytic transfusion reactions. The rare anti-PP1Pk alloantibodies are associated with recurrent spontaneous abortion in the first trimester of gestation. P and Pk antigens are expressed at high levels on the placenta and antibodies directed against both these structures are deleterious to placental trophoblasts. Here we describe the use of plasma exchange (PEX) in a nulliparous 39-year-old woman with anti-PP1Pk antibodies and a history of repeated spontaneous early abortions and hypofertility. The patient underwent apheresis starting from the third week throughout the pregnancy and a healthy child was delivered by cesarean section at 35 WG. The newborn required only phototherapy within a few days of life. We can state that an early treatment with the only PEX has proven to be effective and safe in the management of a fetomaternal P-incompatibility caused by a high anti-PP1Pk titer (256).
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Affiliation(s)
- O Pignalosa
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy.
| | - E Vigorita
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
| | - M Capuano
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
| | - S Caruso
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
| | - A Mastroianni
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
| | - S De Martino
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
| | - G Vaccaro
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
| | - D Meomartini
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
| | - C Nocera
- UOC Medicina Trasfusionale, Ospedale del Mare, ASL Napoli 1 Centro, Italy
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5
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Tseke P, Tsekes P, Griveas I. Use of therapeutic apheresis methods during pregnancy. Transfus Apher Sci 2024; 63:103848. [PMID: 37993288 DOI: 10.1016/j.transci.2023.103848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
This review will focus on the current application of TA in pregnancy and possible aspects for future studies. It seems that scientific interest and field for further research in pregnancy is lately focused in specific removal of pathogens implicated in the physiologic mechanism of pre-eclampsia/HELLP syndrome as well as recurrent pregnancy failure.
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Affiliation(s)
| | - Petros Tsekes
- Renal Unit, General Hospital of Athens "Alexandra", Greece
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6
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Li G, Du M, Deng X, Wang S, Du Q, Bao S. Recurrent miscarriage associated with rare anti-PP1Pk antibody: a case series and literature review.. [DOI: 10.21203/rs.3.rs-2728370/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Abstract
Background: The anti-PP1Pk antibody is a rare antibody associated with recurrent spontaneous abortion (RSA) in the first trimester. As it is a rare entity, few reports have been published, especially in China. Currently, there is no specific treatment for RSA associated with anti-PP1Pk antibody because it is a naturally occurring antibody. This study aims to report three cases of RSA associated with the anti-PP1Pk antibody to share our experiences with its management.
Methods: The three patients' medical information was obtained from the medical records. Intravenous immunoglobulin and/or plasmapheresis was offered to the patients. We also made an extension research of the related literature about RSA associated with anti-PP1Pk antibody.
Results: Although patients received intervention, the maternal anti-PP1Pk antibody titer remained stable and did not decrease. There were no live births. We summarized publications about pregnancy in women with anti-PP1Pk antibodies.
Conclusions: Early initiation of plasmapheresis in high-risk patients with anti-PP1Pk antibodies should be strongly considered.
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Affiliation(s)
- Guohua Li
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Uni
| | - Mengyang Du
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Uni
| | - Xujing Deng
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Uni
| | - Shuping Wang
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Uni
| | - Qiaoling Du
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Uni
| | - Shihua Bao
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji Uni
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7
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Jia S, Li S, Liao Z, Mo C, Fang Q, Luo G, Ji Y. Identification of a novel P1PK allele (A4GALT*c.1-504_1044del1548) in two Chinese sisters with a history of recurrent spontaneous abortion. Transfusion 2022; 62:E52-E54. [PMID: 35929100 DOI: 10.1111/trf.17050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Shuangshuang Jia
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China.,The Key Medical Laboratory of Guangzhou, Guangzhou, China
| | - Si Li
- Department of Obstetrics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhijian Liao
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China.,The Key Medical Laboratory of Guangzhou, Guangzhou, China
| | - Chunyan Mo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China.,The Key Medical Laboratory of Guangzhou, Guangzhou, China
| | - Qun Fang
- Foetal Medicine Centre, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangping Luo
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China.,The Key Medical Laboratory of Guangzhou, Guangzhou, China
| | - Yanli Ji
- Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China.,The Key Medical Laboratory of Guangzhou, Guangzhou, China
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8
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Anliker M, Drees D, Loacker L, Hafner S, Griesmacher A, Hoermann G, Fux V, Schennach H, Hörtnagl P, Dopler A, Schmidt S, Bellmann-Weiler R, Weiss G, Marx-Hofmann A, Körper S, Höchsmann B, Schrezenmeier H, Schmidt CQ. Upregulation of Checkpoint Ligand Programmed Death-Ligand 1 in Patients with Paroxysmal Nocturnal Hemoglobinuria Explained by Proximal Complement Activation. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:1248-1258. [PMID: 35173033 DOI: 10.4049/jimmunol.2100031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hemolytic disease driven by impaired complement regulation. Mutations in genes encoding the enzymes that build the GPI anchors are causative, with somatic mutations in the PIG-A gene occurring most frequently. As a result, the important membrane-bound complement regulators CD55 and CD59 are missing on the affected hematopoietic stem cells and their progeny, rendering those cells vulnerable to complement attack. Immune escape mechanisms sparing affected PNH stem cells from removal are suspected in the PNH pathogenesis, but molecular mechanisms have not been elucidated. We hypothesized that exuberant complement activity in PNH results in enhanced immune checkpoint interactions, providing a molecular basis for the potential immune escape in PNH. In a series of PNH patients, we found increased expression levels of the checkpoint ligand programmed death-ligand 1 (PD-L1) on granulocytes and monocytes, as well as in the plasma of PNH patients. Mechanistically, we demonstrate that complement activation leading to the decoration of particles/cells with C3- and/or C4-opsonins increased PD-L1 expression on neutrophils and monocytes as shown for different in vitro models of classical or alternative pathway activation. We further establish in vitro that complement inhibition at the level of C3, but not C5, inhibits the alternative pathway-mediated upregulation of PD-L1 and show by means of soluble PD-L1 that this observation translates into the clinical situation when PNH patients are treated with either C3 or C5 inhibitors. Together, the presented data show that the checkpoint ligand PD-L1 is increased in PNH patients, which correlates with proximal complement activation.
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Affiliation(s)
- Markus Anliker
- Central Institute for Medical and Chemical Laboratory Diagnosis, University Hospital, Innsbruck, Austria
| | - Daniela Drees
- Institute of Transfusion Medicine, University of Ulm, Ulm, Germany.,Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen and University Hospital of Ulm, Ulm, Germany
| | - Lorin Loacker
- Central Institute for Medical and Chemical Laboratory Diagnosis, University Hospital, Innsbruck, Austria
| | - Susanne Hafner
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University, Ulm, Germany
| | - Andrea Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnosis, University Hospital, Innsbruck, Austria
| | - Gregor Hoermann
- Central Institute for Medical and Chemical Laboratory Diagnosis, University Hospital, Innsbruck, Austria.,MLL Munich Leukemia Laboratory, Munich, Germany
| | - Vilmos Fux
- Central Institute for Medical and Chemical Laboratory Diagnosis, University Hospital, Innsbruck, Austria
| | - Harald Schennach
- Central Institute of Blood Transfusion and Immunology, University Hospital Innsbruck, Innsbruck, Austria
| | - Paul Hörtnagl
- Central Institute of Blood Transfusion and Immunology, University Hospital Innsbruck, Innsbruck, Austria
| | - Arthur Dopler
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University, Ulm, Germany
| | - Stefan Schmidt
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria; and
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Astrid Marx-Hofmann
- Institute of Transfusion Medicine, University of Ulm, Ulm, Germany.,Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen and University Hospital of Ulm, Ulm, Germany
| | - Sixten Körper
- Institute of Transfusion Medicine, University of Ulm, Ulm, Germany.,Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen and University Hospital of Ulm, Ulm, Germany
| | - Britta Höchsmann
- Institute of Transfusion Medicine, University of Ulm, Ulm, Germany.,Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen and University Hospital of Ulm, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute of Transfusion Medicine, University of Ulm, Ulm, Germany; .,Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden-Württemberg-Hessen and University Hospital of Ulm, Ulm, Germany
| | - Christoph Q Schmidt
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University, Ulm, Germany;
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9
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Liu T, Guo X, Liao Y, Liu Y, Zhu Y, Chen X. Correlation Between the Presence of Antinuclear Antibodies and Recurrent Pregnancy Loss: A Mini Review. Front Endocrinol (Lausanne) 2022; 13:873286. [PMID: 35600596 PMCID: PMC9114698 DOI: 10.3389/fendo.2022.873286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
In the past decade, the incidence of recurrent pregnancy loss (RPL) has increased significantly, and immunological disorders have been considered as one of the possible causes contributing to RPL. The presence of antinuclear antibodies (ANAs) is regarded as a typical antibody of autoimmunity. However, the relationship between the presence of ANAs and RPL, the underlying mechanism, and the possible role of immunotherapy is still controversial. The aim of this mini review is to assess the association between ANAs and RPL and the effects of immunotherapy on pregnancy outcomes in women with positive ANAs and a history of RPL from the available data and to provide a relevant reference basis for clinical application in this group of women.
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Affiliation(s)
- Ting Liu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Xi Guo
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ying Liao
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Yingyu Liu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Yuanfang Zhu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
- *Correspondence: Yuanfang Zhu, ; Xiaoyan Chen, ;
| | - Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Yuanfang Zhu, ; Xiaoyan Chen, ;
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10
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Floch A, Lomas-Francis C, Vege S, Chai J, Cai C, Westhoff CM. A novel P1PK allele in two Bangladeshi sisters with a history of spontaneous abortion: A4GALT*02N(951C). Transfusion 2021; 61:E71-E72. [PMID: 34480361 DOI: 10.1111/trf.16649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Aline Floch
- Immunohematology and Genomics Laboratory, New York Blood Center, Long Island City, New York, USA.,Etablissement francais du sang Ile-de-France, Creteil, France.,Univ Paris Est Creteil, INSERM U955 Equipe 2 « Transfusion et maladies du globule rouge », IMRB, Creteil, France
| | - Christine Lomas-Francis
- Immunohematology and Genomics Laboratory, New York Blood Center, Long Island City, New York, USA
| | - Sunitha Vege
- Immunohematology and Genomics Laboratory, New York Blood Center, Long Island City, New York, USA
| | - Jamie Chai
- Immunohematology and Genomics Laboratory, New York Blood Center, Long Island City, New York, USA
| | - Connie Cai
- Immunohematology and Genomics Laboratory, New York Blood Center, Long Island City, New York, USA
| | - Connie M Westhoff
- Immunohematology and Genomics Laboratory, New York Blood Center, Long Island City, New York, USA
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11
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Zarrouk H, Kaabi H, Chaabane M, Halouani L, Hmida S. First successful pregnancy outcome after twelve abortions in a Tunisian-woman with the rare p phenotype. Transfus Clin Biol 2021; 28:283-286. [PMID: 34153474 DOI: 10.1016/j.tracli.2021.06.003] [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: 02/08/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Anti-PP1P k alloantibody, is produced in the serum of individuals with the rare p phenotype. It is associated with severe haemolytic transfusion reactions, recurrent spontaneous early abortions as well as haemolytic disease of the foetus and newborn. Anti-PP1P k alloimmunization in pregnancy differ from others in their physiopathology. It seems that the placenta would be the main target of anti-PP1P k antibody. CASE REPORT This report concerns a 35 year old female, with a history of a high incidence (12) of early and recurrent miscarriages. She was found to have the extremely rare p phenotype and anti-PP1P k antibody in her serum. Her 13th pregnancy was successfully managed by plasmapheresis. No substitution fluid was added. Oral hydration was recommended before and after the apheresis sessions. 12 plasmapheresis cycles were performed before a healthy term female infant weighing 3kg600g, was delivered by caesarean section at 38 weeks of gestation. CONCLUSION Plasmapheresis seems to be the treatment of choice in the management of anti-PP1P k fetomaternal incompatibilities. However in this case, we opted for an original and less expensive protocol. We did resort, neither to substitution fluid nor to intravenous immunoglobulin.
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Affiliation(s)
- H Zarrouk
- Immunohematology Laboratory National Center of Blood Transfusion, Tunis, Tunisia.
| | - H Kaabi
- Immunohematology Laboratory National Center of Blood Transfusion, Tunis, Tunisia
| | - M Chaabane
- Immunohematology Laboratory National Center of Blood Transfusion, Tunis, Tunisia
| | - L Halouani
- Private Hospital Les Jasmins, Tunis, Tunisia
| | - S Hmida
- Immunohematology Laboratory National Center of Blood Transfusion, Tunis, Tunisia
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