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McKelvy M, Tyagi S, Haar EV, Lakkaraja M, Tomy T, Corke S, Palmer T, Rottenstreich A, Kapur R, Zhi H, Newman D, Scatz-Siemers N, Bussel J. Does anti-HPA-1a affect birthweight in fetal and neonatal alloimmune thrombocytopenia? Pediatr Blood Cancer 2024; 71:e30835. [PMID: 38212881 DOI: 10.1002/pbc.30835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Fetal and neonatal alloimmune thrombocytopenia (FNAIT) ensues from parental incompatibility for platelet alloantigens with maternal sensitization. HPA-1a/1b incompatibility is the most common cause of FNAIT in Caucasians. Placental villitis and lower birthweight in FNAIT suggest anti-HPA-1a may have effects beyond inducing thrombocytopenia. OBJECTIVES Does FNAIT secondary to anti-HPA-1a result in smaller newborns and, the corollary, does antenatal management of FNAIT increase birthweight? STUDY DESIGN Birthweights of 270 FNAIT-affected newborns from a randomized clinical trial and a NAITbabies.org survey (135 paired siblings) were compared with those of published controls and treated to untreated FNAIT-affected siblings. Birthweights were converted to percentiles to account for gestational age, sex, and role of birth order in birth weight. Body weights of FNAIT-affected and -unaffected pups in a mouse FNAIT model were analyzed. RESULTS Untreated siblings in both the clinical trial and NAITbabies.org cohorts were not small, compared with normal controls. However, treated siblings in both cohorts had significantly higher birthweight percentiles compared with their previous untreated affected sibling. After accounting for gestational age, sex, and birth order, increased birthweight percentile in treated compared with the untreated siblings remained significant in both cohorts. FNAIT-affected neonatal mice had lower bodyweights than FNAIT-unaffected pups. CONCLUSIONS Untreated FNAIT-affected newborns were not small; however, treatment of FNAIT-affected pregnancies increased newborn birthweights despite corrections to account for other factors that might have influenced the results. High dose IVIG is believed to "block" FcRn and lower maternal anti-HPA-1a levels, and thus increase birthweights by reducing levels of maternal anti-HPA-1a and reducing placental villitis.
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Affiliation(s)
- Margaret McKelvy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Srishti Tyagi
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Emilie Vander Haar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Madhavi Lakkaraja
- Department of Pediatrics, Fred Hutchinson Cancer Center, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
| | - Tim Tomy
- Department of Pediatrics, Hurley Medical Center, Flint, Michigan, USA
| | | | | | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA
- Division of Maternal- Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Rick Kapur
- Department of Experimental Immunohematology, Sanquin Research, and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Huiying Zhi
- Department of Pathology, Versiti Blood Center of Wisconsin, Blood Research Institute, Milwaukee, Wisconsin, USA
| | - Debra Newman
- Department of Pathology, Versiti Blood Center of Wisconsin, Blood Research Institute, Milwaukee, Wisconsin, USA
| | - Nina Scatz-Siemers
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - James Bussel
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
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Knightly KA, Bussel JB, McKelvy M, Vander Haar E. Does absence of intracranial hemorrhage in the first pregnancy in fetal and neonatal alloimmune thrombocytopenia preclude occurrence in the second? Am J Hematol 2024; 99:468-472. [PMID: 38205912 DOI: 10.1002/ajh.27193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Katherine A Knightly
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - James B Bussel
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Margaret McKelvy
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
- Renaissance School of Medicine at Stony Brook University, New York, NY, USA
| | - Emilie Vander Haar
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
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