1
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Huang CE, Chen YY, Chang JJ, Wu YY, Chen WM, Wang YH, Chen MC, Lu CH, Shi CS, Chen CC. The Impact of Human Platelet Antigen Allele on Antiplatelet Antibodies and Cryoglobulins in Patients with Primary Immune Thrombocytopenia and Hepatitis C Virus-Associated Immune Thrombocytopenia. Mediterr J Hematol Infect Dis 2023; 15:e2023030. [PMID: 37180208 PMCID: PMC10171212 DOI: 10.4084/mjhid.2023.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background And Objectives Human platelet antigens (HPAs) are alloantigens associated with antiplatelet alloantibodies and the risk of immune thrombocytopenia (ITP). However, few studies have investigated associations among HPAs, antiplatelet autoantibodies, and cryoglobulins. Methods We enrolled 43 patients with primary ITP, 47 with hepatitis C virus-associated ITP (HCV-ITP), 21 with hepatitis B virus-associated ITP (HBV-ITP), 25 controls with HCV, and 1013 normal controls. We analyzed HPA allele frequencies, including HPA1-6 and 15, antiplatelet antibodies binding to platelet glycoprotein (GP) IIb/IIIa, Ia/IIa, Ib/IX, IV, human leukocyte antigen class I, cryoglobulin IgG/A/M, and their associations with thrombocytopenia. Results In the ITP cohort, HPA2ab, rather than HPA2aa, predicted a low platelet count. HPA2b was associated with the risk of developing ITP. HPA15b was correlated with multiple antiplatelet antibodies. In HCV-ITP patients, HPA3b was correlated with anti-GPIIb/IIIa antibodies. HCV-ITP patients with anti-GPIIb/IIIa antibodies had a higher positive rate of cryoglobulin IgG and IgA compared with those without anti-GPIIb/IIIa antibodies. Overlapping detection was also found among other antiplatelet antibodies and cryoglobulins. Like the antiplatelet antibodies, cryoglobulins were associated with clinical thrombocytopenia, implying their close relationship. Finally, we extracted cryoglobulins to confirm the exhibition of cryoglobulin-like antiplatelet antibodies. In contrast, in primary ITP patients, HPA3b was correlated with cryoglobulin IgG/A/M rather than anti-GPIIb/IIIa antibodies. Conclusion HPA alleles were associated with antiplatelet autoantibodies and had different impacts in primary ITP and HCV-ITP patients. HCV-ITP was considered to be a symptom of mixed cryoglobulinemia in HCV patients. The pathophysiology may differ between these two groups.
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Affiliation(s)
- Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yang Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Ying Wu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Ming Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ying-Hsuan Wang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Min-Chi Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Public Health and Biostatistics Consulting Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Hsien Lu
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chung-Sheng Shi
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Cheng Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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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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3
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Shao Y, Ye X, Xu X, Mai M, Chen D, Liu J, Luo G, Wu J, Xia W, Fu Y. Preliminary mechanism in fetal alloimmune thrombocytopenia associated with anti-HPA 15b antibodies. J Obstet Gynaecol Res 2022; 48:1668-1674. [PMID: 35388576 DOI: 10.1111/jog.15257] [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: 10/17/2021] [Revised: 03/04/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a bleeding disease that can cause fetal hydrops, a rare but life-threatening condition in which abnormal amounts of fluid accumulate in one or two areas of the fetus's body. A case of FNAIT with fetal hydrops caused by anti-HPA-15b antibodies was involved in this study, as we investigated whether or not anti-HPA-15b antibodies can induce endothelial angiogenesis and apoptosis. METHODS The monoclonal antibody immobilization of platelet antigens assay (MAIPA) was used to identify anti-HPA-15b antibodies. The three groups in Tube formation and apoptosis assays were the PBS group, the AB serum IgG group, and the anti-HPA-15b serum IgG group, all reacted with HPA-15bb HUVEC. RESULTS The presence of anti-HPA-15b antibodies was found in this case by MAIPA assay. The OD values are 0.33 and 0.21, reacted with HPA-15bb and HPA-15ab platelets, respectively (cutoff OD value = 0.2). Quantitative analysis revealed that the length of capillary-like tube induced by anti-HPA-15b antibodies was significantly decreased over that of AB serum IgG (*p = 0.0005), but weaker than when incubated with thrombin (**p = 0.0009). The apoptosis results show a significantly increased number of apoptotic endothelial cells in the anti-HPA-15b antibody IgG group when compared with the PBS and AB serum IgG groups (*p < 0.0001, **p < 0.0001). In addition, there is no statistical difference between the PBS and AB serum groups. CONCLUSION Anti-HPA-15b antibodies can inhibit angiogenesis and induce apoptosis. This may associate with hydrops fetalis (HF), or fetal hydrops of FNAIT.
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Affiliation(s)
- Yuan Shao
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
| | - Xin Ye
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
| | - Xiuzhang Xu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
| | - Mingqin Mai
- Medical Genetics Centre, Guangdong Women and Children Hospital, Guangdong, p.R. China
| | - Dawei Chen
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
| | - Jing Liu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
| | - Guangping Luo
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
| | - Jing Wu
- Medical Genetics Centre, Guangdong Women and Children Hospital, Guangdong, p.R. China
| | - Wenjie Xia
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
| | - Yongshui Fu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, p.R. China
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4
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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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5
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Kuroishi A, Takihara Y, Hirayama F. Current understanding and future perspectives for anti-human platelet antigen-15 antibodies in patients with alloimmune thrombocytopenia: History, laboratory testing, and clinical impact. Transfusion 2022; 62:1128-1141. [PMID: 35266549 DOI: 10.1111/trf.16845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ayumu Kuroishi
- Laboratory, Japanese Red Cross Kinki Block Blood Center, Ibaraki-shi, Osaka, Japan
| | | | - Fumiya Hirayama
- Japanese Red Cross Kinki Block Blood Center, Ibaraki-shi, Osaka, Japan
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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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7
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Datta SS, Basu S, Ghara N, Kole P, Khemka P. Utility of platelet cross-matching in a case of neonatal alloimmune thrombocytopenia associated with a de novo MECOM variant. Blood Res 2021; 56:53-56. [PMID: 33542165 PMCID: PMC7987477 DOI: 10.5045/br.2021.2020299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Suvro Sankha Datta
- Department of Transfusion Medicine, Tata Medical Center, Rajarhat, India
| | - Sabita Basu
- Department of Transfusion Medicine, Tata Medical Center, Rajarhat, India
| | - Niharendu Ghara
- Department of Pediatric Hematology, Tata Medical Center, Rajarhat, India
| | - Pulak Kole
- Department of Pediatrics and Neonatology, Bhagirathi Neotia Woman and Child Care Centre, Kolkata, India
| | - Priti Khemka
- Department of Pediatrics and Neonatology, Bhagirathi Neotia Woman and Child Care Centre, Kolkata, India
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8
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Minkov M, Zeitlhofer P, Zoubek A, Kager L, Panzer S, Haas OA. Novel Compound Heterozygous Mutations in Two Families With Bernard-Soulier Syndrome. Front Pediatr 2020; 8:589812. [PMID: 33553065 PMCID: PMC7864212 DOI: 10.3389/fped.2020.589812] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Bernard-Soulier Syndrome (BSS) is a rare autosomal recessive bleeding disorder with large platelets and thrombocytopenia. It is caused by homozygous or compound heterozygous mutations in the GP1BA, GP1BB, or GP9 genes, which together encode the platelet surface receptor glycoprotein complex GPIb-IX-V. Objectives: We report two novel heterozygous mutations in the GP1BA and the GP9 genes, respectively. Patients/Methods: We analyzed the platelet glycoprotein expression by flow cytometry and screened the relevant genes for responsible mutations in two unrelated families. Results: Flow cytometric analyses revealed the absence of CD42a (GPIX) and CD42b (GPIb) on the platelets in the two affected siblings of family 1 and a significantly reduced expression of CD42b (GPIb) in the patient of family 2. In the two siblings, we identified a known frameshift (c.1601_1602delAT) and a novel nonsense mutation (c.1036C>T) in the GP1BA gene that abrogated the production of GP1bα. In the other patient, we found a novel missense mutation (c.112T>C) that was co-inherited with a common one (c.182A>G) in the GP9 gene, respectively. All analyzed heterozygous carriers were asymptomatic and had a normal GPIb-IX-V expression. Conclusions: The two novel GP1BA and GP9 mutations reported herein increment the number of causative genetic defects in BSS.
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Affiliation(s)
- Milen Minkov
- Department of Pediatrics, Clinic Floridsdorf, Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria.,St. Anna Children's Hospital, Department of Pediatric Hematology/Oncology, University Clinic of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Petra Zeitlhofer
- Labdia GmbH, St. Anna Kinderkrebsforschung GmbH, Vienna, Austria
| | - Andreas Zoubek
- Private Practice for General Pediatrics and Pediatric Hematology/Oncology, Maria Enzersdorf, Austria
| | - Leo Kager
- St. Anna Children's Hospital, Department of Pediatric Hematology/Oncology, University Clinic of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | - Oskar A Haas
- St. Anna Children's Hospital, Department of Pediatric Hematology/Oncology, University Clinic of Pediatrics, Medical University of Vienna, Vienna, Austria.,Labdia GmbH, St. Anna Kinderkrebsforschung GmbH, Vienna, Austria
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10
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Tiller H, Husebekk A, Ahlen MT, Stuge TB, Skogen B. Current perspectives on fetal and neonatal alloimmune thrombocytopenia - increasing clinical concerns and new treatment opportunities. Int J Womens Health 2017; 9:223-234. [PMID: 28458583 PMCID: PMC5402885 DOI: 10.2147/ijwh.s90753] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Differences in platelet type between the fetus and the mother can lead to maternal immunization and destruction of the fetal platelets, a condition named fetal and neonatal alloimmune thrombocytopenia (FNAIT). FNAIT is reported to occur in ~1 per 1,000 live born neonates. The major risk is intracranial hemorrhage in the fetus or newborn, which is associated with severe neurological complications or death. Since no countries have yet implemented a screening program to detect pregnancies at risk, the diagnosis is typically established after the birth of a child with symptoms. Reports on broader clinical impact have increased clinical concern and awareness. Along with new treatment options for FNAIT, the debate around antenatal screening to detect pregnancies at risk of FNAIT has been revitalized.
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Affiliation(s)
- Heidi Tiller
- Immunology Research Group, Faculty of Health Sciences, UiT, The Arctic University of Norway
| | - Anne Husebekk
- Immunology Research Group, Faculty of Health Sciences, UiT, The Arctic University of Norway
| | | | - Tor B Stuge
- Immunology Research Group, Faculty of Health Sciences, UiT, The Arctic University of Norway
| | - Bjørn Skogen
- Department of Laboratory Medicine, Norwegian National Unit for Platelet Immunology, University Hospital of North Norway, Tromsø, Norway
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11
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Reiher VS, Hönger G, Infanti L, Passweg JR, Hösli I, Frey BM, Gassner C, Meyer S, Buser AS, Holbro A, Schaub S. Human platelet antigen antibody induction in uncomplicated pregnancy is associated with HLA sensitization. Transfusion 2017; 57:1272-1279. [DOI: 10.1111/trf.14053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gideon Hönger
- Transplantation Immunology and Nephrology, University Hospital Basel
| | - Laura Infanti
- Regional Blood Transfusion Service; Swiss Red Cross
- Division of Hematology; University Hospital Basel
| | | | - Irene Hösli
- Department for Obstetrics and Fetomaternal Medicine; University Hospital Basel; Basel Switzerland
| | - Beat M. Frey
- Regional Blood Transfusion Service; Swiss Red Cross Zürich Switzerland
| | - Christoph Gassner
- Regional Blood Transfusion Service; Swiss Red Cross Zürich Switzerland
| | - Stefan Meyer
- Regional Blood Transfusion Service; Swiss Red Cross Zürich Switzerland
| | - Andreas S. Buser
- Regional Blood Transfusion Service; Swiss Red Cross
- Division of Hematology; University Hospital Basel
| | - Andreas Holbro
- Regional Blood Transfusion Service; Swiss Red Cross
- Division of Hematology; University Hospital Basel
| | - Stefan Schaub
- Transplantation Immunology and Nephrology, University Hospital Basel
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12
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Al-Ouda SK, Al-Banyan AA, Al-Gahtani FH, Abdel-Gader AGM, Al-Dakhil LO. Antibodies against human platelet alloantigens and human leucocyte antigen class 1 in Saudi Arabian multiparous women and multi-transfused patients. Saudi Med J 2016; 36:665-70. [PMID: 25987107 PMCID: PMC4454899 DOI: 10.15537/smj.2015.6.11153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the frequency of alloimmunization against human platelet antigens (HPAs) and human leucocyte antigen class 1 (HLA1) in multiparous women and multi-transfused patients. METHODS This prospective study was conducted between January and August 2013, on 50 multiparous women with no history of previous blood transfusion recruited from the Obstetrics and Gynecology Clinic, and 50 patients, who received multiple platelet transfusions, recruited from the Hematology/Oncology Ward, King Khalid University Hospital, Riyadh, Saudi Arabia. RESULTS The frequency of alloimmunization among multiparous pregnant women was 76%, as follows: 16% against HLA1 only, 8% against HPAs only, 52% against both HPAs and HLA1 antigens. In multi-transfused patients, the rate of alloimmunization was 42% as follows: 2% against HLA1 only, 22% against HPAs only, 18% against both HPAs and HLA1 antigens. The frequency of alloimmunization increases with the number of pregnancies, but not with the number of platelet transfusions. CONCLUSION Alloimmunization against HPAs and HLA1 is very common among Saudi multiparous women and multi-transfused patients, which encourages the search for the extent of the possible complications in the fetus and newborn and in multitransfused patients and how to prevent their occurrence.
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Affiliation(s)
- Sarah K Al-Ouda
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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13
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Matsuhashi M, Tsuno NH, Sone S, Mishima Y, Nagura Y, Watanabe-Okochi N, Ikeda T, Kashiwase K, Fukuda S, Iriyama T, Hyodo H, Yamashita T, Kamei Y, Arai S, Minami M, Fujii T, Kurokawa M, Tozuka M, Takahashi K, Santoso S. The role of alloantibodies against human platelet antigen-15 in multiply platelet transfused patients. Transfusion 2013; 54:1093-9. [DOI: 10.1111/trf.12455] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Mika Matsuhashi
- Department of Transfusion Medicine; The University of Tokyo; Giessen Germany
- Analytical Laboratory Chemistry, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Nelson H. Tsuno
- Department of Transfusion Medicine; The University of Tokyo; Giessen Germany
| | - Shinji Sone
- Department of Transfusion Medicine; The University of Tokyo; Giessen Germany
| | - Yuko Mishima
- Department of Transfusion Medicine; The University of Tokyo; Giessen Germany
| | - Yutaka Nagura
- Department of Transfusion Medicine; The University of Tokyo; Giessen Germany
| | | | - Toshiyuki Ikeda
- Department of Transfusion Medicine; The University of Tokyo; Giessen Germany
| | - Koichi Kashiwase
- HLA Laboratory; Japanese Red Cross Kanto-Koshinetsu Block Blood Center; Giessen Germany
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology; The University of Tokyo Hospital; Giessen Germany
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology; The University of Tokyo Hospital; Giessen Germany
| | - Hironobu Hyodo
- Department of Obstetrics and Gynecology; The University of Tokyo Hospital; Giessen Germany
| | - Takahiro Yamashita
- Department of Obstetrics and Gynecology; The University of Tokyo Hospital; Giessen Germany
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology; The University of Tokyo Hospital; Giessen Germany
| | - Shunya Arai
- Department of Hematology & Oncology; The University of Tokyo; Giessen Germany
| | - Mutsuhiko Minami
- HLA Laboratory; Japanese Red Cross Kanto-Koshinetsu Block Blood Center; Giessen Germany
| | - Tomoyuku Fujii
- Department of Obstetrics and Gynecology; The University of Tokyo Hospital; Giessen Germany
| | - Mineo Kurokawa
- Department of Hematology & Oncology; The University of Tokyo; Giessen Germany
| | - Minoru Tozuka
- Analytical Laboratory Chemistry, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Koki Takahashi
- Department of Transfusion Medicine; The University of Tokyo; Giessen Germany
| | - Sentot Santoso
- Immunohematology Research Department; Institute for Clinical Immunology and Transfusion Medicine; Giessen Germany
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Curtis BR, McFarland JG. Human platelet antigens - 2013. Vox Sang 2013; 106:93-102. [PMID: 24102564 DOI: 10.1111/vox.12085] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 08/12/2013] [Accepted: 08/21/2013] [Indexed: 01/25/2023]
Abstract
To date, 33 human platelet alloantigens (HPAs) have been identified on six functionally important platelet glycoprotein (GP) complexes and have been implicated in alloimmune platelet disorders including foetal and neonatal alloimmune thrombocytopenia (FNAIT), posttransfusion purpura (PTP) and multitransfusion platelet refractoriness (MPR). The greatest number of recognized HPA (20 of 33) resides on the GPIIb/IIIa complex, which serves as the receptor for ligands important in mediating haemostasis and inflammation. These include HPA-1a, the most commonly implicated HPA in FNAIT and PTP in Caucasian populations. Other platelet GP complexes, GPIb/V/IX, GPIa/IIa and CD109, express the remaining 13 HPAs. Of the recognized HPAs, 12 occur as six serologically and genetically defined biallelic 'systems' where the -a form designates the higher frequency allele and the -b form, the lower. Twenty-one other HPAs are low-frequency or rare antigens for which postulated higher frequency -a alleles have not yet been identified as antibody specificities. In addition to the HPA markers, platelets also express ABO and human leucocyte antigen (HLA) antigens; antibodies directed at the former are occasionally important in FNAIT, and to the latter, in MPR.
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Affiliation(s)
- B R Curtis
- Platelet & Neutrophil Immunology Laboratory, BloodCenter of Wisconsin, Milwaukee, WI, USA
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15
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Abstract
Although neonatal thrombocytopenia (platelet count < 150×10(9) /l) is a common finding in hospital practice, a careful clinical history and examination of the blood film is often sufficient to establish the diagnosis and guide management without the need for further investigations. In preterm neonates, early-onset thrombocytopenia (<72h) is usually secondary to antenatal causes, has a characteristic pattern and resolves without complications or the need for treatment. By contrast, late-onset thrombocytopenia in preterm neonates (>72h) is nearly always due to post-natally acquired bacterial infection and/or necrotizing enterocolitis, which rapidly leads to severe thrombocytopenia (platelet count<50×10(9) /l). Thrombocytopenia is much less common in term neonates and the most important cause is neonatal alloimmune thrombocytopenia (NAIT), which confers a high risk of perinatal intracranial haemorrhage and long-term neurological disability. Prompt diagnosis and transfusion of human platelet antigen-compatible platelets is key to the successful management of NAIT. Recent studies suggest that more than half of neonates with severe thrombocytopenia receive platelet transfusion(s) based on consensus national or local guidelines despite little evidence of benefit. The most pressing problem in management of neonatal thrombocytopenia is identification of safe, effective platelet transfusion therapy and controlled trials are urgently needed.
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Affiliation(s)
- Subarna Chakravorty
- Centre for Haematology, Imperial College London, London Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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16
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Maślanka K, Michur H, Guz K, Wróbel A, Uhrynowska M, Misiak A, Ejduk A, Brojer E, Zupańska B. The relevance of HPA-15 antigen expression for anti-HPA-15 antibody detection. Int J Lab Hematol 2011; 34:65-9. [PMID: 21752233 DOI: 10.1111/j.1751-553x.2011.01358.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The HPA-15 antigen system is characterized by a low antigen expression on platelets. The antibodies against this antigen are implied in fetal/neonatal alloimmune thrombocytopenia (F/NAIT), post-transfusion purpura, and refractoriness to platelet transfusions. Detection of these antibodies appears to be related to the level of HPA-15 expression on the platelets used in the monoclonal antibody-specific immobilization of platelet antigen (MAIPA) assay. METHODS We performed genotyping of 300 healthy blood donors for HPA-15 by TaqMan real-time PCR technology, and the HPA-15 antigen expression was investigated in 13 HPA-15aa and 19 HPA-15bb individuals. We also investigated the relevance of HPA-15 antigen expression on donor platelets used in MAIPA for antibody detection in 223 multitransfused hematological patients and 271 women with suspected F/NAIT. RESULTS In Polish donors, the HPA-15a allele frequencies were lower than the HPA-15b (0.480 vs. 0.515). We identified three HPA-15 expression groups: high (36.7 ± 8.36 MFI - eight cases), medium (19.5 ± 6.2 MFI - 21 cases), and low (6.5 ± 5.9 MFI - three cases). The HPA-15 expression was stable over time. The HPA-15aa and HPA-15bb platelets with high antigen expression were used for anti-HPA-15 antibody detection; anti-HPA-15 antibodies were detected in 4/223 (1.8%) patients receiving multiple transfusions but in none of the 271 women with suspected F/NAIT. Further examination of the four sera by MAIPA with various platelets revealed the optical density in the assay to be closely related to the level of HPA-15 antigen expression. CONCLUSION Anti-HPA-15 antibody detection should be based on carefully selected platelets with high HPA-15 expression level.
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Affiliation(s)
- K Maślanka
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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17
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Haselboeck J, Pabinger I, Ay C, Koder S, Panzer S. Platelet activation and function during eltrombopag treatment in immune thrombocytopenia. Ann Hematol 2011; 91:109-13. [DOI: 10.1007/s00277-011-1249-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 04/27/2011] [Indexed: 11/24/2022]
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Novelli S, Canals C, Nogués N, Julià MR, Gracia M, Vinyets I, Muñiz-Diaz E. Severe neonatal alloimmune thrombocytopaenia with anaemia. Transfus Med 2010; 20:125-6. [DOI: 10.1111/j.1365-3148.2009.00974.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Matsuhashi M, Tsuno NH, Kawabata M, Yokoyama T, Tazaki Y, Takashima T, Oda H, Kuroda Y, Nagayoshi Y, Morita S, Shibata Y, Santoso S, Takahashi K. The first case of alloantibody against human platelet antigen-15b in Japan: possible alloimmunization by a hydatidiform mole. Transfusion 2009; 50:1126-30. [PMID: 20030792 DOI: 10.1111/j.1537-2995.2009.02537.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The involvement of the human platelet antigen (HPA)-15 system in neonatal alloimmune thrombocytopenia (NAIT) has been reported in various populations, but not in the Japanese population. In Japan, the mixed passive hemagglutination assay (MPHA) is used for detection of HPA alloantibodies. However, most of the reported cases of HPA-15 incompatibility are based on the monoclonal antibody immobilization of platelet antigen (MAIPA) assay or immunoprecipitation; thus there is a possibility that HPA-15 alloantibodies are not efficiently detected by the MPHA, and currently, the causative antibody is not detectable in approximately half of the suspected NAIT cases in Japan. STUDY DESIGN AND METHODS We examined the sera of mothers from NAIT cases, previously with undetected HPA antibodies by MPHA, using the MAIPA technique. Sera from 90 mothers of suspected NAIT were tested by MAIPA for the presence of anti-HPA-15 alloantibodies. RESULTS Anti-HPA-15b was detected in one case. This case was a mother in the first pregnancy diagnosed as hydatid mole-coexisting fetus, and the baby was born with suspected NAIT. The familial analysis revealed compatibility of HPA-15 genotype between the mother and the baby (both HPA-15a/a), but incompatibility with the paternal one (HPA-15a/b). The hydatid mole's tissue was genotyped as HPA-15b positive. Besides anti-HPA-15b, maternal sera contain strong HLA Class I antibody CONCLUSIONS Here we reported the first case of anti-HPA-15 in Japan. Alloimmunization against the hydatid mole seems to be responsible for the production of HPA-15b alloantibody. This antibody, however, did not apparently involve in the development of NAIT of the newborn, the coexisting anti-HLA Class I being the possible cause.
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Affiliation(s)
- Mika Matsuhashi
- Department of Transfusion Medicine, The University of Tokyo, Tokyo, Japan
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20
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Gramatges MM, Fani P, Nadeau K, Pereira S, Jeng MR. Neonatal alloimmune thrombocytopenia and neutropenia associated with maternal human leukocyte antigen antibodies. Pediatr Blood Cancer 2009; 53:97-9. [PMID: 19229975 DOI: 10.1002/pbc.21979] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neonatal thrombocytopenia or neutropenia may result from passive transfusion of maternally derived antibodies. Antibodies against platelet antigens are commonly associated with neonatal alloimmune thrombocytopenia (NAIT), and anti-neutrophil antibodies are frequently identified in alloimmune neonatal neutropenia (ANN). Combined alloimmune cytopenias in the newborn are rarely reported; even fewer reports document human leukocyte antigen (HLA) antibodies as a potential cause of neonatal thrombocytopenia or neutropenia. We describe neutropenia and thrombocytopenia in a newborn associated with markedly elevated maternal HLA antibodies in the absence of anti-neutrophil or anti-platelet antibodies to highlight consideration of HLA antibodies in the pathogenesis of ANN and NAIT.
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Affiliation(s)
- M Monica Gramatges
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California 94107, USA
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21
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Ghevaert C, Rankin A, Huiskes E, Porcelijn L, Javela K, Kekomaki R, Bakchoul T, Santoso S, Nutland S, Smyth DJ, Smith GA, McBride S, Watkins NA, Ouwehand WH. Alloantibodies against low-frequency human platelet antigens do not account for a significant proportion of cases of fetomaternal alloimmune thrombocytopenia: evidence from 1054 cases. Transfusion 2009; 49:2084-9. [PMID: 19500319 DOI: 10.1111/j.1537-2995.2009.02246.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maternal alloantibodies against the five common human platelet antigen (HPA) systems (HPA-1 to -3, -5, and -15) are found in only 20% of cases referred for fetal and neonatal thrombocytopenia (FMAIT) investigations. The question asked was whether mismatches for the remaining 11 low-frequency HPAs (HPA-4 and -6bw to -17bw) might in part explain the remaining 80% of cases. STUDY DESIGN AND METHODS A total of 1054 paternal DNA samples from referred FMAIT cases (among which 223 cases where antibodies against a common HPA were found) were genotyped for 11 low-frequency HPAs as well as a recently discovered polymorphism (ITGA2B-C2320T). The initial genotyping was carried out by TaqMan and potential heterozygotes were confirmed by DNA sequencing. Clinical and serologic data were collected for each case with a heterozygote father. RESULTS In total, eight heterozygous fathers were identified: four for HPA-6w, one each for HPA-10w and -11w, and two for HPA-12w. Maternal antibodies against the corresponding antigen were identified in four of the eight cases. In two of these cases, antibodies against HPA-1a and HPA-1b were also found. CONCLUSION It was concluded that the minor alleles of HPA-4 and -6bw to -17bw are exceptionally rare in the Caucasian population and therefore do not explain the large number of FMAIT referrals which test negative for the common HPA antibodies.
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Affiliation(s)
- Cedric Ghevaert
- Department of Haematology, University of Cambridge, Cambridge, UK.
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22
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Porcelijn L, van Beers W, Gratama JW, van't Veer M, De Smet A, Sintnicolaas K. External quality assessment of platelet serology and human platelet antigen genotyping: a 10-year review. Transfusion 2008; 48:1699-706. [DOI: 10.1111/j.1537-2995.2008.01748.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Fetal/Neonatal Allo-Immune Thrombocytopenia (FNAIT): Past, Present, and Future. Obstet Gynecol Surv 2008; 63:239-52. [DOI: 10.1097/ogx.0b013e31816412d3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Berry J, Allen D, Porcelijn L, de Haas M, Kekomaki R, Kaplan C, Ouwehand WH, Metcalfe P. Collaborative studies to establish the first World Health Organization International Standard for detection of human antibody against human platelet antigen-3a. Vox Sang 2007; 93:309-15. [PMID: 18070275 DOI: 10.1111/j.1423-0410.2007.00899.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The platelet-specific antibody anti-human platelet antigen-3a (anti-HPA-3a) is involved in neonatal alloimmune thrombocytopenia, post-transfusion purpura, and platelet refractoriness. However, HPA-3a antibodies are often difficult to detect, probably because the antigen is labile. This report describes the production of a freeze-dried preparation of pooled human plasma, coded 03/190, containing IgG antibodies against the HPA-3a. The material is intended for use as a minimum sensitivity reagent in glycoprotein-specific assays currently used for anti-HPA-3a detection. Laboratories can use it to assess the sensitivity of their 'in-house' assays for anti-HPA-3a and to calibrate local controls for routine use in each batch of tests. MATERIALS AND METHODS Plasma containing anti-HPA-3a was obtained from a mother of two babies both born with severe thrombocytopenia, and following dilution it was freeze dried in glass ampoules. RESULTS Two collaborative studies demonstrated that the candidate material contained anti-HPA-3a and human leucocyte antigen (HLA) class I antibodies, but no other HPA antibodies that might confuse the detection of the anti-HPA-3a. The minimum dilution that should give a positive result was determined to be 1 : 8 by two further international collaborative studies involving a total of 49 laboratories in 23 countries. CONCLUSION The material also contains HLA antibodies and is suitable for use only in techniques that are glycoprotein specific (i.e. monoclonal antibody immobilization of platelet antigens and enzyme-linked immunosorbent assay) where only HPA antibodies will be detected. This standard will allow laboratories to measure their sensitivity of detection of anti-HPA-3a and will also allow those laboratories with relatively insensitive techniques to monitor their performance as they improve their methodology.
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Affiliation(s)
- J Berry
- National Institute for Biological Standards and Control, Potters Bar, Hertfordshire, UK
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Moncharmont P, Courvoisier S, Pagnier A, Cotta L, Debillon T, Rigal D. Severe HPA-15b related neonatal alloimmune thrombocytopenia. Acta Paediatr 2007; 96:1701-3. [PMID: 17850392 DOI: 10.1111/j.1651-2227.2007.00483.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The HPA-15 platelet (PLT) group was recently described. Severe neonatal thrombocytopenia due to alloimmunization by HPA-15b has very rarely been observed. A 22-year-old mother, gravida 1/para 1, gave birth to a male infant who presented with a severe thrombocytopenia, the PLT count recorded to be 3 x10(9)/L. A few hours after birth, he developed purpura with extensive haematomas but without visceral or intracranial haemorrhage (ICH). Two PLT transfusions were given including one using maternal PLTs. The infant's PLT count was 267 x 10(9)/L on day 6. The maternal platelet group was HPA-15a/a and her infant was HPA-15a/b. Anti-HPA-15b antibodies was found in maternal serum. CONCLUSION HPA-15b maternal alloimmunization may induce severe neonatal thrombocytopenia. In order to establish the frequency of neonatal alloimmune thrombocytopenia (NAIT) due to anti-HPA-15b antibodies, an improved detection method is necessary.
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MESH Headings
- Adult
- Antigens, CD/blood
- Antigens, CD/immunology
- Antigens, Human Platelet/blood
- Antigens, Human Platelet/immunology
- Blood Group Incompatibility/complications
- Blood Group Incompatibility/diagnosis
- Blood Group Incompatibility/therapy
- Cesarean Section
- Female
- GPI-Linked Proteins
- Humans
- Infant, Newborn
- Male
- Maternal-Fetal Exchange/immunology
- Neoplasm Proteins/blood
- Neoplasm Proteins/immunology
- Platelet Transfusion
- Pregnancy
- Pregnancy Complications, Hematologic/immunology
- Purpura, Thrombocytopenic/etiology
- Thrombocytopenia, Neonatal Alloimmune/diagnosis
- Thrombocytopenia, Neonatal Alloimmune/immunology
- Thrombocytopenia, Neonatal Alloimmune/therapy
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Affiliation(s)
- P Moncharmont
- French Blood Establishment, Rhône-Alpes Lyon Department, Lyon, France.
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Soundravally R, Hoti SL. Immunopathogenesis of dengue hemorrhagic fever and shock syndrome: role of TAP and HPA gene polymorphism. Hum Immunol 2007; 68:973-9. [PMID: 18191725 DOI: 10.1016/j.humimm.2007.09.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 08/27/2007] [Accepted: 09/20/2007] [Indexed: 12/01/2022]
Abstract
Clinical outcomes of dengue infection such as dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) could be attributed to host genetic factors. The transporters associated with antigen processing (TAP) genes are polymorphic genes located in the human leukocyte antigen (HLA) class II region and are essentially involved in class I antigen presentation. Therefore, these genes might grant susceptibility to severe dengue infection. Hence, the aim of the study was to type the TAP1 gene (using amplification refraction mutation system [ARMS] polymerase chain reaction [PCR]) and HPA1 and HPA2 gene polymorphism (by PCR-sequence specific primers) in different clinical spectrums of dengue infection. The study included 100 controls and 91 DF, 75 DHF, and 32 DSS patients. The results revealed that the frequencies of valine at TAP1 333 and HPA 1b at HPA1 were increased among DHF and DSS, respectively, in comparison to controls (p <0.05). The frequency of genotype TAP1 333 ILE/VAL (61.3%) was significantly higher in DHF compared with control (37%, p = 0.005) or DF (38.9%, p = 0.007) patients. A significantly greater proportion of DHF patients demonstrated HPA1a/1a and HPA 2a/2b genotypes than DF patients. DSS patients were more likely to be heterozygous at HPA1 than DHF (OR = 4.75, p = 0.003). A positive correlation existed between TAP1 333 and HPA1 in DHF (p = 0.017, r = 0.229). This first report on TAP and HPA gene polymorphism in dengue suggested that the heterozygous pattern at the TAP1 333 locus and HPA1a/1a and HPA2a/2b genotypes confer susceptibility to DHF and the HPA1a/1b genotype was determined to be a genetic risk factor for DSS.
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Affiliation(s)
- R Soundravally
- Department of Molecular Biology and Bioinformatics, Vector Control Research Centre, Pondicherry, India
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28
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Panzer S, Rieger M, Vormittag R, Eichelberger B, Dunkler D, Pabinger I. Platelet function to estimate the bleeding risk in autoimmune thrombocytopenia. Eur J Clin Invest 2007; 37:814-9. [PMID: 17727674 DOI: 10.1111/j.1365-2362.2007.01855.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Knowledge of platelet function may assist in patient care in chronic autoimmune thrombocytopenia (cAITP). MATERIALS AND METHODS We evaluated the association of platelet function with haemorrhage in 41 patients, median age 41 years (range 14-82 years, 24 females) with chronic autoimmune thrombocytopenia (cAITP). Samples were investigated for platelet P-selectin, and adhesion and aggregate formation under high shear conditions. Data were compared to those from 28 healthy controls (median age 39 years, range 23-70 years, 17 females) and correlated with a bleeding score of 0 (no bleeding) to 3 (overt mucosal bleedings). RESULTS P-selectin levels were higher in patients than in controls (P < 0.0004). Compared to controls, the patients' samples responded to high shear with decreased adhesion to the polystyrene surface (P < 0.0001), but formed aggregates of normal size. P-selectin expression was neither correlated with platelet counts, nor platelet adhesion, nor the bleeding score. Only the size of formed aggregates correlated with P-selectin (P = 0.01). Platelet counts (odds ratio 0.5, 95% confidence interval 0.22-0.88; P = 0.04) and adhesion (odds ratio 0.45, 95% confidence interval 0.17-0.87; P = 0.04) were independently inversely correlated with bleeding symptoms. CONCLUSION Platelet adhesion correlates with bleeding symptoms, while the size of aggregates that are formed under high shear correlates with in vivo platelet activation. The determination of these parameters may assist in estimating an individual bleeding risk and thus a decision for treatment.
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Affiliation(s)
- S Panzer
- Clinic for Blood Group Serology, Medical University of Vienna, Vienna, Austria.
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Ringwald J, Schroth M, Faschingbauer F, Strobel J, Strasser E, Schild RL, Goecke TW. Intrauterine use of hyperconcentrated platelet concentrates collected with Trima Accel in a case of neonatal alloimmune thrombocytopenia. Transfusion 2007; 47:1488-93. [PMID: 17655593 DOI: 10.1111/j.1537-2995.2007.01288.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Due to the threat of serious or fatal bleedings, fetuses with neonatal alloimmune thrombocytopenia (NAIT) may need intrauterine platelet (PLT) transfusions. To prevent a volume overload or an ABO minor mismatch, standard PLT concentrates need to be washed to increase the PLT concentration and to reduce the plasma content. Hyperconcentrated single-donor PLT concentrates (HCPs) are a therapeutic alternative. The first case of NAIT successfully treated with HCPs collected with the Trima Accel (TA; Gambro BCT) is reported. CASE REPORT A 31-year-old woman with a history of NAIT in the preceding pregnancy underwent cordocentesis three times during her third pregnancy (30th, 31st, and 32nd weeks of gestation). NAIT was confirmed by marked fetal thrombocytopenia, a maternal anti-human PLT antigen (HPA)-1a-immunoglobulin G (titer 1:128), and the appropriate HPA genotype of the fetus and the parents. On each cordocentesis procedure, a distinct volume of a HPA-1a-negative HCP with a PLT concentration of 3 x 10(6) PLTs per microL was transfused resulting in high corrected count increments after 2 hours. The HCPs were transfused within 10 hours after collection. One day after the last cordocentesis procedure, a cesarean section was performed. The newborn did not show any bleeding signs, and the PLT count remained on normal levels and no further PLT transfusions were needed. CONCLUSION HCPs collected with TA are a useful alternative to washed standard PLT concentrates without the need for further manipulation of the product after collection. Further in vitro and in vivo studies are needed, however, to make definite recommendations for the shelf life of these HCP.
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Affiliation(s)
- Juergen Ringwald
- Department of Transfusion Medicine and Hemostaseology, University Hospital of Erlangen, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
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Ghevaert C, Campbell K, Walton J, Smith GA, Allen D, Williamson LM, Ouwehand WH, Ranasinghe E. Management and outcome of 200 cases of fetomaternal alloimmune thrombocytopenia. Transfusion 2007; 47:901-10. [PMID: 17465957 DOI: 10.1111/j.1537-2995.2007.01208.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetomaternal alloimmune thrombocytopenia (FMAIT) is the commonest cause of severe thrombocytopenia in term neonates but its management remains controversial. STUDY DESIGN AND METHODS A 7-year prospective observational study of 200 cases of FMAIT evaluated the relationship between human platelet antigen (HPA) antibody specificity, clinical presentation, morbidity, mortality, and therapeutic interventions in the antenatal and postnatal period, with long-term follow-up of neonates with intracranial hemorrhage (ICH). RESULTS In 1148 referrals for FMAIT, HPA antibodies were confirmed in 200 (17%). The commonest specificities were anti-HPA-1a, 150 (75%); anti-HPA-5b, 31 (15.5%); and anti-HPA-15b, 8 (4%). Of 123 (62%) cases (two sets of twins) with no previous history of FMAIT, intrauterine deaths occurred in 5: anti-HPA-1a alone, 3; in combination with anti-HPA-5b, 1; and anti-HPA-15b, 1. Of the 120 live neonates, 103 had severe thrombocytopenia and 17 (14%) developed ICH (anti-HPA-1a, 13; anti-HPA-5b, 3; anti-HPA-15b, 1). Postnatal care varied widely with 37 percent of neonates receiving random rather than HPA-1a and -5b-negative platelets. Of the remaining 77 cases with a history of FMAIT, 40 received intrauterine transfusions. Six (15%) of these fetuses died in utero and an additional 2 developed ICH postnatally. Of the 19 children with ICH, 1 (anti-HPA-15b) died on Day +1, and neurologic sequelae persist in 13 (mean follow-up, 2.5 years). CONCLUSION HPA-1a antibodies are most commonly implicated in severe thrombocytopenia but HPA-5b and HPA-15b antibodies can also result in poor outcome. Postnatal transfusion management is extremely variable, and fetal transfusions are associated with significant morbidity and mortality.
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Affiliation(s)
- Cedric Ghevaert
- National Blood Service Cambridge, Cambridge and Oxford, Department of Haematology, University of Cambridge, Cambridge, UK.
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32
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Meyer O, Agaylan A, Bombard S, Kiesewetter H, Salama A. A novel antigen-specific capture assay for the detection of platelet antibodies and HPA-1a phenotyping. Vox Sang 2007; 91:324-30. [PMID: 17105608 DOI: 10.1111/j.1423-0410.2006.00839.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The antigen-specific assays currently used for the laboratory investigation of platelet antibodies and antigens are technically complex and cannot be used in most routine laboratories. Here, we describe a simple antigen-specific capture assay (ASCA) for the detection of serum platelet antibodies and for human platelet antigen-1a (HPA-1a) phenotyping. MATERIALS AND METHODS For the detection of platelet antibodies, platelets from healthy blood donors were incubated with biotinylated monoclonal antibodies to platelet glycoprotein complexes (GP), then solubilized and mixed with superparamagnetic streptavidin particles. Serum samples from patients with autoimmune thrombocytopenia (n = 39), from patients with platelet alloantibodies (6 HPA-1a, 1 HPA-2b, 1 HPA-3a, 6 HPA-5b), and from healthy blood donors (n = 70), were tested. All serum samples from the patients were investigated in parallel by the indirect monoclonal antibody-specific immobilization of platelet antigen assay (MAIPA). For HPA-1a phenotyping, superparamagnetic particles were coated with a monoclonal antibody to HPA-1a and mixed with diluted whole blood samples from healthy blood donors (n = 139), who had previously been genotyped for platelet alloantigens. Results The indirect MAIPA detected autoantibodies in 18%, and the direct MAIPA in 50% of patients tested. In contrast, the new ASCA demonstrated positive results in 77% of patients. All tested alloantibodies reacted positive by the ASCA, and all serum samples from healthy blood donors were negative. The results of HPA-1a phenotyping were in concordance with those of genotyping in all cases. CONCLUSION In our opinion, the ASCA is easy to perform and much more sensitive than the currently available antigen-specific assays for the detection of platelet antibodies.
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Affiliation(s)
- O Meyer
- Charité, Universitätsmedizin Berlin, Institut für Transfusionsmedizin, Berlin, Germany
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Deruelle P, Wibaut B, Manessier L, Subtil D, Vaast P, Puech F, Valat AS. [Is a non-invasive management allowed for maternofetal alloimmune thrombocytopenia? Experience over a 10-year period]. ACTA ACUST UNITED AC 2007; 35:199-204. [PMID: 17306591 DOI: 10.1016/j.gyobfe.2007.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 01/09/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Our purpose was to study a non-invasive management of fetomaternal alloimmune thrombocytopenia (FMAIT). PATIENTS AND METHODS Between 1996 and 2005, 18 women were treated. The population was divided into 2 groups: patients with a history of intracranial haemorrhage (ICH) in the older sibling received weekly intravenous immunoglobulin (IVIG) therapy to the mother (1 g/kg per week) without initial cordocentesis whereas patients with a history of neonatal thrombocytopenia did not undergo any treatment. RESULTS All pregnancies with a previous FMAIT were monitored with serial ultrasound scans without cordecentesis. 15 patients had HPA-1, 2 HPA-3 and 1 HPA-5 immunizations. Weekly intravenous immunoglobulin therapy was administered in 5 patients with a history of ICH in the older sibling. Two of these delivered thrombocytopenic children; one had a platelet count < 50 x 10(9)/l. For the 13 women (one twin) who had a sibling with neonatal thrombocytopenia, 11/14 newborns had a platelet count < 50 x 10(9)/l. Predelivery fetal blood sampling were performed in 8/18 pregnancies. The neonatal periods of the 19 children were uncomplicated and no ICHs were observed. DISCUSSION AND CONCLUSION Our results suggest that a non-invasive strategy avoiding serial cordocentesis may be an effective therapy in patients who are at risk of fetal and neonatal alloimmune thrombocytopenia.
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Affiliation(s)
- P Deruelle
- Clinique de Gynécologie, d'Obstétrique et de Néonatologie, Hôpital Jeanne-de-Flandre, Centre Hospitalier Régional Universitaire (CHRU) de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
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Roberts IA, Murray NA. Thrombocytopenia in the Newborn. Platelets 2007. [DOI: 10.1016/b978-012369367-9/50814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Panzer S, Höcker L, Vormittag R, Rieger M, Koren D, Dunkler D, Pabinger I. Flow cytometric evaluation of platelet activation in chronic autoimmune thrombocytopenia. Pediatr Blood Cancer 2006; 47:694-6. [PMID: 16933254 DOI: 10.1002/pbc.21000] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Platelets from 42 patients (platelet counts median 42x10(9)/L, range 3-223x10(9)/L) with chronic idiopathic autoimmune thrombocytopenia (cAITP) were investigated for P-Selectin expression and PAC-1 binding. The results showed that the levels of P-Selectin positive platelets (n=20) were higher in cAITP than in controls (P<0.0001), and correlated with platelet counts (P=0.04). PAC-1 binding was increased in only six patients, and not correlated with platelet counts. There was no correlation of P-Selectin or PAC-1 with detectable platelet antibodies. Thus, platelets are activated in cAITP, but platelets, characterized by PAC-1 binding, are rare. These are either needed to maintain vascular integrity, or underwent premature sequestration.
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Affiliation(s)
- Simon Panzer
- Clinic for Blood Group Serology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria.
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Male C, Koren D, Eichelberger B, Kaufmann K, Panzer S. Monitoring survival and function of transfused platelets in Glanzmann thrombasthenia by flow cytometry and thrombelastography. Vox Sang 2006; 91:174-7. [PMID: 16907879 DOI: 10.1111/j.1423-0410.2006.00797.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with Glanzmann thrombasthenia (GT) may form isoantibodies which induce refractoriness or inhibition of function of transfused platelets. We monitored the survival and function of transfused platelets by flow cytometry and thrombelastography in a patient with GT. Gating on CD42a+ allowed identification of even a few transfused platelets. Only by gating on these CD41+ CD42a+ cells were we able to demonstrate their capability to bind fibrinogen and PAC-1 upon activation. Platelets were rapidly cleared from the circulation as a result of boosted isoantibodies. The contribution of transfused platelets to clot formation was also demonstrated by thrombelastography by blocking their function with abciximab.
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Affiliation(s)
- C Male
- Department for Pediatrics, Medical University Vienna, Austria
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Nguyen XD, Klüter H. The SASPA (Simultaneous Analysis of Specific Platelet Antibodies) Assay: Implementation and Performance in the Routine Laboratory Use. Transfus Med Hemother 2006. [DOI: 10.1159/000092861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Panzer S, Mayr WR, Eichelberger B. Light chain phenotypes of HLA antibodies in cases with suspected neonatal alloimmune thrombocytopenia. Vox Sang 2005; 89:261-4. [PMID: 16262761 DOI: 10.1111/j.1423-0410.2005.00693.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Platelet-specific antibodies are detectable in only about 30% in suspected neonatal alloimmune thrombocytopenia (NAIT). Human leucocyte antigen (HLA) class I antibodies are often detectable, and as platelets express the corresponding antigens, it has been suggested that these antibodies can be responsible for NAIT. Light chain phenotyping may assist in the diagnosis of HLA antibodies-induced NAIT. MATERIALS AND METHODS We determined light chain phenotypes of platelet reactive HLA antibodies in 17 sera from mothers who delivered offspring with suspected NAIT. Ten sera also contained platelet-specific antibodies: HPA-1a (n = 5, one with HPA-15b), HPA-5b (n = 4) and autoantibodies (n = 1). Sera were tested for kappa or lambda restriction by monoclonal antibody-specific immobilization of platelet antigens (MAIPA). RESULTS The cross-match with paternal platelets was positive in all cases due to HLA antibodies. We identified 5, 3 and 3 sera to contain lymphocytotoxic antibodies of single, two or multiple specificities, respectively. In six cases, HLA antibodies were only detectable by MAIPA. Light chain restriction (n = 9) was not associated with HPA containing antibodies or to any pattern of the HLA antibodies. Similarly, polyclonal antibodies (n = 8) were seen in all categories. CONCLUSION We show that pregnancy-associated HLA antibodies can be clonal or polyclonal, irrespective of a diagnosis of NAIT. ONE-SENTENCE SUMMARY: Pregnancy associated HLA antibodies can be clonal or polyclonal, irrespective a diagnosis of NAIT.
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MESH Headings
- Antigens, Human Platelet/immunology
- Autoantibodies/blood
- Autoantibodies/immunology
- Female
- HLA Antigens/immunology
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/immunology
- Male
- Maternal-Fetal Exchange/immunology
- Pregnancy
- Purpura, Thrombocytopenic, Idiopathic/blood
- Purpura, Thrombocytopenic, Idiopathic/immunology
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Affiliation(s)
- S Panzer
- Clinic for Blood Group Serology, Medical University of Vienna, Vienna, Austria.
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Addendum. Vox Sang 2005. [DOI: 10.1111/j.1423-0410.2005.00689.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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