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Langerak T, Bakker G, Porcelijn L, Lauw M, van de Laar R, Eefting M. Vaccine-induced immune thrombocytopenia and thrombosis after mRNA-1273 booster vaccination. Thromb Res 2022; 214:21-22. [PMID: 35429895 PMCID: PMC8979885 DOI: 10.1016/j.thromres.2022.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/27/2022]
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Abstract
Human platelet antibody (HPA) detection is necessary for the diagnosis and therapeutic decisions for refractoriness to platelet transfusions, post transfusion purpura and fetal and neonatal alloimmune thrombocytopenia. In the last four to five decades many new developments, both in knowledge and methods, have increased the quality of platelet serology. However, the quest for the optimal antibody detection method(s) encountered, sometimes unexpected, difficulties. In this review the various aspects concerning platelet antibody test methods and detection of platelet antibodies both for the diagnostic and screening setting are discussed.
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Affiliation(s)
- L Porcelijn
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands.
| | - E Huiskes
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands
| | - M de Haas
- Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
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de Kruijff E, van Gammeren AJ, Porcelijn L, van Esser JWJ. Post-transfusion purpura in a woman with acute myeloid leukemia. Neth J Med 2019; 77:81-83. [PMID: 30895931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Post-transfusion purpura (PTP) is a rare, but severe transfusion reaction in which both donor and autologous platelets are sequestered due to immunization against HPA-1a antigens in HPA-1a negative recipients (HPA: human platelet antigens). We describe a patient who developed PTP during induction therapy for acute myeloid leukaemia. The pitfalls, delays in diagnosing and therapy options of this serious transfusion reaction are discussed.
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Affiliation(s)
- E de Kruijff
- Departments of 1nternal Medicine, Amphia Hospital, Breda, the Netherlands
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van Stein D, Beckers EAM, Peters AL, Porcelijn L, Middelburg RA, Lardy NM, van Rhenen DJ, Vlaar APJ. Underdiagnosing of antibody-mediated transfusion-related acute lung injury: evaluation of cellular-based versus bead-based techniques. Vox Sang 2016; 111:71-8. [DOI: 10.1111/vox.12383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/03/2016] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- D. van Stein
- Department of Internal Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - E. A. M. Beckers
- Department of Internal Medicine-Hematology; Maastricht University Medical Center; Maastricht The Netherlands
| | - A. L. Peters
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - L. Porcelijn
- Sanquin Diagnostics; Sanquin Blood Bank; Amsterdam The Netherlands
| | - R. A. Middelburg
- Center for clinical transfusion research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - N. M. Lardy
- Sanquin Diagnostics; Sanquin Blood Bank; Amsterdam The Netherlands
| | - D. J. van Rhenen
- South West Region; Sanquin Blood Bank; Rotterdam The Netherlands
| | - A. P. J. Vlaar
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
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Rosner A, Lachmann R, Hirchenhain C, Porcelijn L, Kamin G, Hölig K. Versorgung einer Zweitschwangerschaft nach fetaler/neonataler Alloimmunthrombozytopenie (FNAIT) von HPA-1a-heterozygotem Vater. Transfusionsmedizin 2013. [DOI: 10.1055/s-0032-1325065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Rosner
- Bereich Transfusionsmedizin, Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden
| | - R. Lachmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - C. Hirchenhain
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - L. Porcelijn
- Platelet/Leukocyte Serology Laboratory/Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - G. Kamin
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - K. Hölig
- Bereich Transfusionsmedizin, Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden
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Lucas G, Porcelijn L, Fung YL, Green F, Reil A, Hopkins M, Schuller R, Green A, de Haas M, Bux J. External quality assessment of human neutrophil antigen (HNA)-specific antibody detection and HNA genotyping from 2000 to 2012. Vox Sang 2013; 105:259-69. [PMID: 23663230 DOI: 10.1111/vox.12041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/14/2013] [Accepted: 03/19/2013] [Indexed: 11/30/2022]
Abstract
Since 2000, Quality Assurance (QA) exercises for the detection and identification of granulocyte antibodies and DNA typing for human neutrophil antigens (HNA) have been distributed within the International Granulocyte Immunobiology Workshops, which are linked to International Society of Blood Transfusion. The exercises were standardised at the outset to enable laboratory performance to be monitored. Between 2000 and 2012, nine exercises were distributed to 20 laboratories. Overall, 45 examples of 42 unique samples containing defined granulocyte reactive antibodies were distributed for serological analysis together with 20 samples for HNA genotyping. The level of satisfactory serological performance was initially set at 50% and later increased to 70%, while the 'cut-off' for HNA genotyping was set at 100% after 2008. Failure to achieve the minimum score in the QA exercises in consecutive years resulted in temporary exclusion. In 2000, the 15 participating laboratories had a mean score of 56.1% for serological analysis and 13 laboratories attempted HNA-1a and -1b genotyping, while 11 attempted HNA-1c typing. Steady improvements in proficiency for serological testing and HNA typing occurred in subsequent exercises. In 2012, the mean score for serology was 88.5% and 12/13 laboratories scored 100% for HNA-1a, -1b, -1c, -3a, -3b, -4a, -4bw, -5a and -5bw genotyping. These QA exercises have provided an invaluable tool to monitor and improve the standard of granulocyte immunology investigations for participating laboratories, thereby enhancing performance for both clinical investigations and donor screening programmes to reduce the incidence of TRALI.
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Affiliation(s)
- G Lucas
- Histocompatibility and Immunogenetics, NHS Blood and Transplant, Bristol, UK
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Madani K, Kamphuis MM, Lopriore E, Porcelijn L, Oepkes D. Delayed diagnosis of fetal and neonatal alloimmune thrombocytopenia: a cause of perinatal mortality and morbidity. BJOG 2012; 119:1612-6. [DOI: 10.1111/j.1471-0528.2012.03503.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Middelburg RA, Beckers EAM, Porcelijn L, Lardy N, Wiersum-Osselton JC, Schipperus MR, Vrielink H, Briët E, van der Bom JG. Allo-exposure status and leucocyte antibody positivity of blood donors show a similar relation with TRALI. Transfus Med 2012; 22:128-32. [PMID: 22380759 DOI: 10.1111/j.1365-3148.2012.01140.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The fraction of transfusion-related acute lung injury (TRALI) cases preventable by deferral of allo-exposed donors has previously been estimated, under the assumption this indirectly estimated the contribution of leucocyte antibodies to the occurrence of TRALI. Our aim was to estimate the fraction preventable by deferral of leucocyte antibody positive donors and to investigate the validity of allo-exposure as a marker for leucocyte antibodies. METHODS All donors involved in a series of previously published TRALI patients were tested for leucocyte antibodies. The observed number of antibody positive donors was compared to the expected number. From this comparison we estimated the contribution of leucocyte antibodies to the occurrence of TRALI and compared this to the previously reported estimate for allo-exposed donors. RESULTS Sixty-one TRALI patients were included. Of 288 involved donors 43 were expected and 67 were observed to be leucocyte antibody positive. The observed percentage of positive donors was 8.3% (95% confidence interval (CI): 5.1-11.5%) in excess of the expected. Overall 59% (95% CI: 34-85%) of TRALI cases was estimated to be preventable by the exclusion of all leucocyte antibody positive donors. For plasma-poor products this was 16% (95% CI: -5.0 to 36%). CONCLUSIONS These estimates were similar to those previously published for allo-exposed donors. This suggests allo-exposure status can effectively be used in donor deferral strategies.
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Affiliation(s)
- R A Middelburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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Kamphuis MM, Paridaans N, Porcelijn L, De Haas M, van der Schoot CE, Brand A, Bonsel GJ, Oepkes D. Screening in pregnancy for fetal or neonatal alloimmune thrombocytopenia: systematic review. BJOG 2010; 117:1335-43. [DOI: 10.1111/j.1471-0528.2010.02657.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bierling P, Bux J, Curtis B, Flesch B, Fung L, Lucas G, Macek M, Muniz-Diaz E, Porcelijn L, Reil A, Sachs U, Schuller R, Tsuno N, Uhrynowska M, Urbaniak S, Valentin N, Wikman A, Zupanska B. Recommendations of the ISBT Working Party on Granulocyte Immunobiology for leucocyte antibody screening in the investigation and prevention of antibody-mediated transfusion-related acute lung injury. Vox Sang 2008; 96:266-9. [PMID: 19207164 DOI: 10.1111/j.1423-0410.2008.01144.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is currently one of the most common causes of transfusion-related major morbidity and death. Among the many TRALI mediators, leucocyte antibodies have been identified as important triggers of severe TRALI. STUDY DESIGN AND METHODS These recommendations were compiled by experts of the ISBT Working Party on Granulocyte Immunobiology, based on the results obtained in eight international granulocyte immunology workshops, their personal experiences and on published study results. RESULTS Leucocyte antibody screening has to include the detection of human leucocyte antigen (HLA) class I, class II and human neutrophil alloantigen antibodies using established and validated techniques. HLA class I antibody detection should be restricted to antibodies clinically relevant for TRALI. To avoid unnecessary workload, TRALI diagnosis should be assessed by consultation with the reporting clinician and thorough exclusion of transfusion-associated circulatory overload/cardiac insufficiency. In patients diagnosed with TRALI having donors with detectable leucocyte antibodies, evidence of leucocyte incompatibility should be provided by either cross-matching or typing of patient for cognate antigen. CONCLUSION Leucocyte antibody screening for the immunological clarification of TRALI cases as well as for identification of potentially alloimmunized blood donors is feasible and can be performed in a reasonable and quality assured manner. This practice can contribute to the prevention of antibody-mediated TRALI.
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Affiliation(s)
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- Platelet and Leucocyte Immunology Laboratory, EFS Ile de France, Hopital Henri Mondor, Creteil, France
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Porcelijn L, Huiskes E, Maatman R, de Kreuk A, de Haas M. Acquired Glanzmann's thrombasthenia caused by glycoprotein IIb/IIIa autoantibodies of the immunoglobulin G1 (IgG1), IgG2 or IgG4 subclass: a study in six cases. Vox Sang 2008; 95:324-30. [DOI: 10.1111/j.1423-0410.2008.01093.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wiersum-Osselton JC, Porcelijn L, van Stein D, Vlaar APJ, Beckers EAM, Schipperus MR. [Transfusion-related acute lung injury (TRALI) in the Netherlands in 2002-2005]. Ned Tijdschr Geneeskd 2008; 152:1784-1788. [PMID: 18754313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine the number of reported cases of transfusion-related acute lung injury (TRALI) in the Netherlands in 2002-2005 and to determine how many cases were associated with incompatibility between leukocyte-reactive antibodies in the donor plasma and leukocytes or antigens in the recipient. DESIGN Retrospective national case review. METHOD Cases of TRALI reported in 2002-2005 were assessed according to the national clinical definition of TRALI, and the relationship between TRALI and transfusion was assessed. Additional clinical details were requested from the treating hospital as necessary. The results of leukocyte serological tests from donors and recipients were linked to clinical cases. For cases with positive leukocyte serological tests, the relevant blood components and the sex of the donor were recorded. RESULTS Of the 46 cases reported, 6 had insufficient information. 8 cases did not meet the definition or had another more likely diagnosis. There was a trend toward an increase in the number of reports: 12 cases were reported in 2005, corresponding with 1:60,000 blood components. Of the 40 evaluable cases, 32 (80%) met the definition of TRALI and were deemed to be definitely (n = 16), probably (n = 5) or possibly (n = 11) related to transfusion. Severity ranged from moderate to life-threatening, and there was one TRALI-related death. Leukocyte serology was fully investigated in 18 cases: 13 (72%) had leukocyte incompatibility and in 5 cases exclusively fresh frozen plasma from a female donor was implicated.
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Abstract
Fetal thrombocytopenia is most often caused by maternal alloantibodies against fetal platelets crossing the placenta and resulting in platelet destruction. This condition, known as fetal and neonatal alloimmune thrombocytopenia, is usually detected after the birth of a symptomatic child who shows signs of bleeding in the skin or in the brain. In the most severe cases, intracranial hemorrhage leads to severe handicap or death. The challenge for the clinician is to provide preventive treatment in the next pregnancy. The current cornerstone of this treatment is maternal intravenous administration of immunoglobulins during the second half of pregnancy.
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Affiliation(s)
- L Porcelijn
- Department of Immunohaematology Diagnostic Services, Sanquin Diagnostic Services (CLB), Amsterdam, The Netherlands
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Kanhai HHH, Porcelijn L, Engelfriet CP, Reesink HW, Panzer S, Ulm B, Goldman M, Bonacossa I, Richard L, David M, Taaning E, Hedegaard M, Kaplan C, Kiefel V, Meyer O, Salama A, Morelati F, Greppi N, Marconi M, Tassis B, Tsuno NH, Takahashi K, Oepkes D, Porcelijn L, Kanhai H, Osnes LTN, Husebekk A, Killie MK, Kjeldsen-Kragh J, Zupanska B, Muñiz-Diaz E, Nogués N, Parra J, Urbaniak SJ, Cameron A. Management of alloimmune thrombocytopenia. Vox Sang 2008; 93:370-85. [PMID: 18070283 DOI: 10.1111/j.1423-0410.2007.00980.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H H H Kanhai
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
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De Haan TR, Van Den Akker ESA, Porcelijn L, Oepkes D, Kroes ACM, Walther FJ. Thrombocytopenia in hydropic fetuses with parvovirus B19 infection: incidence, treatment and correlation with fetal B19 viral load. BJOG 2007; 115:76-81. [DOI: 10.1111/j.1471-0528.2007.01555.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Wester JPJ, Leyte A, Oudemans-van Straaten HM, Bosman RJ, van der Spoel JI, Haak EAF, Porcelijn L, Zandstra DF. Low-dose fondaparinux in suspected heparin-induced thrombocytopenia in the critically ill. Neth J Med 2007; 65:101-8. [PMID: 17387236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND In critically ill patients, heparin-induced thrombocytopenia (HIT) is estimated to account for approximately 1 to 10% of all causes of thrombocytopenia. HIT exerts a strong procoagulant state. In case of suspected HIT, it is an important clinical decision to stop heparin and start treatment with alternative nonheparin anticoagulation, awaiting the results of laboratory testing for the final diagnosis of HIT (bridging therapy). Fondaparinux acts by factor Xa inhibition and expresses no cross-reactivity with HIT antibodies. Excretion of fondaparinux is mainly renal. We describe our early experience with fixed low-dose fondaparinux bridging therapy and monitoring of anticoagulant activity for safety reasons. METHODS This retrospective cohort study was conducted in a closed format general intensive care unit in a teaching hospital. Consecutive critically ill patients suspected of HIT were treated with fondaparinux after discontinuation of unfractionated heparin or nadroparin. Anti-Xa levels were determined afterwards. RESULTS Seven patients were treated with fondaparinux 2.5 mg/day for 1.8 to 6.5 days. Anti-Xa levels varied from 0.1 to 0.6 U/ml. A negative correlation was found between creatinine clearance and mean and maximum anti-Xa levels. No thromboembolic complications occurred. Bleeding complications were only minor during fondaparinux treatment. Transfusion requirements did not differ significantly between treatment episodes with fondaparinux or with heparin anticoagulants. CONCLUSION In this small sample of critically ill patients suspected of HIT, bridging therapy with fixed low-dose fondaparinux resulted in prophylactic and therapeutic anti-Xa levels. Monitoring of anticoagulant activity is advised in patients with renal insufficiency.
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Affiliation(s)
- J P J Wester
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM Amsterdam, the Netherlands.
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Abstract
Thrombopoietin (Tpo) is the main hematopoietic growth factor for platelet production. Plasma Tpo levels in autoimmune thrombocytopenic patients are normal or slightly elevated. Although thrombocytopenia exists, Tpo levels are not increased because the produced megakaryocytes and platelets can bind circulating Tpo, thereby normalizing Tpo levels. In this study, plasma samples from fetuses and neonates with neonatal alloimmune thrombocytopenia (NAIT), a different form of immune thrombocytopenia, were measured. Umbilical cord samples from 50 fetuses before treatment because of severe thrombocytopenia and 51 fetuses after treatment, and peripheral blood samples of 21 untreated newborns with NAIT were analyzed. As controls, plasma Tpo levels were determined in 21 umbilical cord samples of 14 nonthrombocytopenic fetuses with hemolytic disease resulting from red blood cell alloimmunization and in umbilical cord samples of 51 healthy newborns. The values were also compared with the plasma Tpo levels in 193 healthy adults. Mean Tpo levels from the groups of fetuses and neonates, including both NAIT and control plasma, were slightly but significantly elevated compared with levels in healthy adults. Tpo levels in NAIT samples were not significantly different from the levels in hemolytic disease samples or in samples from healthy newborns. Thus, as in autoimmune thrombocytopenic patients, normal Tpo levels are present in NAIT patients.
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Affiliation(s)
- L Porcelijn
- Sanquin Diagnostics, Amsterdam, The Netherlands.
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20
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Abstract
OBJECTIVE Fetal and neonatal alloimmune thrombocytopenia (AIT) caused by feto-maternal incompatibility at the HPA-1a (PLA-1) locus is well characterized. Alloimmunization and disease caused by HPA-3a is rare. STUDY DESIGN We conducted a retrospective analysis of all known cases of AIT caused by HPA-3a incompatibility identified at 3 major reference laboratories from 1986 to 1996. Platelet antigen typing and antibody specificity were determined by serologic evaluation. In some cases confirmatory genotyping was performed. RESULTS Fourteen cases of anti-HPA-3a-induced AIT in 11 families were identified. Five patients had a previous affected sibling, and 2 cases were firstborn children. All patients had severe thrombocytopenia at birth (platelet count <20 x 10(9)/L). Regardless of therapy, the median time to platelet recovery was 6 days (range, 3 to 23 days). Two (15%) patients had documented intracranial hemorrhage, 1 with severe sequelae including apnea and convulsions. A literature review describing 16 additional patients corroborates the finding of severe thrombocytopenia and a significant incidence of intracranial hemorrhage caused by HPA-3a incompatibility. CONCLUSION AIT caused by incompatibility of HPA-3a is similar in severity to disease caused by incompatibility of HPA-1a. Affected families should be appropriately counseled and considered for antenatal therapy.
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Affiliation(s)
- J Glade-Bender
- Department of Pediatrics, Division of Hematology/Oncology, New York Presbyterian Hospital, 525 E 68th St., P695, New York, NY 10021, USA
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Engelfriet CP, Reesink HW, Garratty G, Knight R, de Silva M, Contreras M, Overbeeke MA, Porcelijn L, Lin M, So CC, Schmidt-Melbye AC, Heier HE, Sokol RJ, Booker DJ, Stamps R, Barbolla L, Zamora C, Hernández-Jodra M, Goldman M, Long A, Décary F. The detection of alloantibodies against red cells in patients with warm-type autoimmune haemolytic anaemia. Vox Sang 2000; 78:200-7. [PMID: 10838523 DOI: 10.1159/000031181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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de Haas M, Muniz-Diaz E, Alonso LG, van der Kolk K, Kos M, Buddelmeijer L, Porcelijn L, von dem Borne AE. Neutrophil antigen 5b is carried by a protein, migrating from 70 to 95 kDa, and may be involved in neonatal alloimmune neutropenia. Transfusion 2000; 40:222-7. [PMID: 10686007 DOI: 10.1046/j.1537-2995.2000.40020222.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neutrophil antigen 5b has been described as involved in transfusion reactions and not in neonatal alloimmune neutropenia. CASE REPORT Anti-5b was found in the serum of a mother of a persistently neutropenic newborn, who had several bacterial infections. The neutropenia responded to treatment with recombinant human granulocyte-colony-stimulating factor. Immunoprecipitation experiments performed with this and three other 5b antisera identified a protein, migrating from 70 to 95 kDa, as carrier of 5b. The observed pattern of migration may point to heavy glycosylation of this protein. RESULTS Six 5b-negative donors were identified among 54 screened white donors, for a 5b gene frequency of 0.66. CONCLUSION Alloimmunization to 5b in pregnancy is rare. In the patients with neonatal neutropenia analyzed in the last decade, this was the first case discovered.
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Affiliation(s)
- M de Haas
- Central Laboratory of the Netherlands Red Cross, Amsterdam.
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von dem Borne AE, Folman C, Linthorst GE, Porcelijn L, van den Oudenrijn S, van der Schoot E, de Haas M. Thrombopoietin and its receptor: structure, function and role in the regulation of platelet production. Baillieres Clin Haematol 1998; 11:409-26. [PMID: 10097817 DOI: 10.1016/s0950-3536(98)80058-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- A E von dem Borne
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
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25
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Porcelijn L, Folman CC, Bossers B, Huiskes E, Overbeeke MA, v d Schoot CE, de Haas M, von dem Borne AE. The diagnostic value of thrombopoietin level measurements in thrombocytopenia. Thromb Haemost 1998; 79:1101-5. [PMID: 9657431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
It has been reported that blood trombopoietin (TPO) levels can discriminate between thrombocytopenia due to increased platelet destruction and decreased platelet production. With our TPO ELISA and a glycocalicin ELISA we analysed a large group of patients in detail and could confirm and amplify the above notion in detail. TPO levels were determined in plasma from 178 clinically and serologically well-defined thrombocytopenic patients: 72 patients with idiopathic autoimmune thrombocytopenia (AITP), 29 patients with secondary AITP, 5 patients with amegakaryocytic thrombocytopenia and 72 patients who suffered from various diseases (46 in whom megakaryocyte deficiency was not and 26 in whom it was expected). In addition, we measured the level of glycocalicin as a marker of total body mass of platelets. In all patients with primary AITP and secondary AITP, TPO levels were within the normal range or in some (n = 7) cases only slightly increased. The level of glycocalicin was not significantly different from that of the controls (n = 95). The patients with amegakaryocytic thrombocytopenia had strongly elevated TPO levels and significantly decreased glycocalicin levels. Similarly, among the 72 thrombocytopenic patients with various disorders, elevated TPO levels were only found in patients in whom platelet production was depressed. The mean level of glycocalicin in these patients was decreased compared to that in controls and patients with AITP, but was not as low as in patients with amegakaryocytic thrombocytopenia. In conclusion, all patients with depressed platelet production had elevated levels of circulating TPO, whereas the TPO levels in patients with an immune-mediated thrombocytopenia were mostly within the normal range. Therefore, measurement of plasma TPO levels provides valuable diagnostic information for the analysis of thrombocytopenia in general. Moreover, treatment with TPO may be an option in AITP.
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Affiliation(s)
- L Porcelijn
- Central Laboratory of The Netherlands Red Cross Blood Transfusion Service, Amsterdam
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26
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von dem Borne AE, Folman C, Linthorst GE, Porcelijn L, van den Oudenrijn S, van der Schoot E, de Haas M. Thrombopoietin: its role in platelet disorders and as a new drug in clinical medicine. Baillieres Clin Haematol 1998; 11:427-45. [PMID: 10097818 DOI: 10.1016/s0950-3536(98)80059-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A E von dem Borne
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
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27
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Abstract
Acute idiopathic or autoimmune thrombocytopenic purpura (AITP) is a disorder found mainly in children, usually preceded by a viral infection, with a higher incidence in the autumn and winter. The platelet-specific autoantibodies in acute childhood AITP are more often of the IgM class. Chronic AITP occurs mostly in adults. The platelet immunofluorescence test (PIFT) detects platelet-specific autoantibodies with a sensitivity of 65-75%. The autoantibodies in chronic AITP are classified as IgG in 95%, IgM in 26% and IgA in 4% of cases. The antibodies are usually bound to platelets and are detectable as free circulating antibodies in about 40%. AITP in pregnancy may cause neonatal AITP by autoantibodies of the IgG class which pass the placenta barrier. The rare neonatal alloimmune thrombocytopenic purpura (NAITP) are caused by IgG alloantibodies against HPA-1a in 75-90%, HPA1b in 3-5%, HPA 3a in 4-5%, HPA5b in 6-19% and against private platelet antigens in 3%. To confirm the diagnosis of NAITP requires extensive serological testing of the child, and the parents have to be typed for the important platelet-specific antigens by PIFT, monoclonal antibody immobilisation of platelet antigens (MAIPA) and/or enzyme-linked immunosorbent assay (ELISA) techniques. Three mechanisms of drug-induced thrombocytopenias are described. Platelets of both the donor and the patient are destroyed in post-transfusion thrombocytopenic purpura (PTP) but PTP does not occur again if incompatible platelets are re-administered.
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Affiliation(s)
- L Porcelijn
- Department of Experimental Immunohematology, CLB, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
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Abstract
In idiopathic thrombocytopenic purpura, the low risk of fetal bleeding in the perinatal period does not justify routine cordocentesis. Platelet counts of second newborns correlates well with that of their siblings. In neonatal alloimmune thrombocytopenia, the initial platelet count at cordocentesis in the second trimester is low in the next pregnancy. Weekly high doses of intravenous gammaglobulin to the mother results in a rise of fetal platelet count in approximately 70% of cases and may protect the fetus against intracranial haemorrhage in cases without significant platelet rise. With the exception of cases with a prior infant with spontaneous fetal intracranial haemorrhage, the use of diagnostic fetal blood sampling to confirm neonatal alloimmune thrombocytopenia is controversial.
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Affiliation(s)
- L Porcelijn
- CLB, Sanguin Blood Supply Foundation, Amsterdam, The Netherlands
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29
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Westman P, Hashemi-Tavoularis S, Blanchette V, Kekomäki S, Laes M, Porcelijn L, Kekomäki R. Maternal DRB1*1501, DQA1*0102, DQB1*0602 haplotype in fetomaternal alloimmunization against human platelet alloantigen HPA-6b (GPIIIa-Gln489). Tissue Antigens 1997; 50:113-8. [PMID: 9271820 DOI: 10.1111/j.1399-0039.1997.tb02849.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fetomaternal incompatibility of platelet alloantigens may lead to alloimmunization and neonatal alloimmune thrombocytopenia (NAIT). Human platelet alloantigen (HPA) 6b, which associates with residue Gln 489 of platelet membrane glycoprotein IIIa, has been described as a cause of NAIT. We have studied the MHC genes of all available family members in the six thus far reported families with a thrombocytopenic newborn and fetomaternal HPA-6b incompatibility. Maternal HPA-6b antibodies could be detected in five mothers to the altogether seven thrombocytopenic male infants. The MHC genes HLA-DRB, -DQA1, -DQB1, -DPB1, TAP1,2 and HSP70-Hom were studied by using polymerase chain reaction (PCR)-based DNA analysis methods. All five mothers with detectable circulating HPA-6b antibodies at the time of delivery shared an identical DRB1*1501, DQA1*0102, DQB1*0602 haplotype. The sixth, HPA antibody negative mother and a HPA-6b-negative mother to a healthy HPA-6b+ child were negative for this haplotype. The frequency of DRB1*15-positive haplotype was increased in immunized mothers (100%) as compared with the general Finnish population (27%), but the association was not statistically significant after correction. We conclude that there is a potential association between the MHC haplotype DRB1*1501, DQA1*0102, DQB1*0602 and alloimmunization to the HPA-6b antigen and that this alloimmunization probably involves different HLA class II molecules from immunization to HPA-1a.
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Affiliation(s)
- P Westman
- Finnish Red Cross Blood Transfusion Service, Helsinki, Finland.
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Vlasveld LT, de Haas M, Ermens AA, Porcelijn L, van Marion-Kievit JA, von dem Borne AE. G-CSF-induced decrease of the anti-granulocyte autoantibody levels in a patient with autoimmune granulocytopenia. Ann Hematol 1997; 75:59-64. [PMID: 9322685 DOI: 10.1007/s002770050313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present a case of an 81-year-old man with secondary autoimmune granulocytopenia in association with autoimmune thrombocytopenia. Treatment with granulocyte colony-stimulating factor (G-CSF) (5 micrograms/ kg/day s.c.) resulted in a rapid increase in the number of circulating granulocytes with a pronounced left shift. These changes were accompanied by up-regulation of the surface expression of Fc gamma RI (CD64) and Fc gamma RII (CD32) on the granulocytes. In addition, we noted a strong up-regulation of the Fc gamma RIII (CD16) and the activation markers CD11b and CD66b on the granulocytes. The increase in the number of circulating granulocytes was followed by a dramatic decrease in the level of cell-bound as well as circulating anti-granulocyte antibodies. It is hypothezised that the decrease in the level of cell-bound as well as circulating anti-granulocyte antibodies may be the result of an increased adsorption of the antibodies by the granulocytes.
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Affiliation(s)
- L T Vlasveld
- Department of Internal Medicine, Diaconessenhuis, Eindhoven, The Netherlands
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Kanhai HH, Porcelijn L, van Zoeren D, Klumper F, Viëtor H, Meerman RH, Brand A. Antenatal care in pregnancies at risk of alloimmune thrombocytopenia: report of 19 cases in 16 families. Eur J Obstet Gynecol Reprod Biol 1996; 68:67-73. [PMID: 8886684 DOI: 10.1016/0301-2115(96)02485-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess accuracy of a management program in patients at risk for alloimmune thrombocytopenia (NAITP) and to describe perinatal outcomes. STUDY DESIGN Nineteen fetuses at risk of thrombocytopenia were identified using obstetric history, HLA type of the mother and fetal phenotyping in cases where paternal heterozygozity for the offending antigen was present. Cordocentesis was timed according to obstetric history and performed with safety precautions to prevent haemorrhage. High dose intravenous gamma globulin (IVIG) was administered to the mother in cases with a fetal platelet count < 100 x 10(9)/l. RESULTS The platelet antagonisms were distributed as follows: HPA-1a in 15 patients, HPA-5a in two, HPA-3a in one, with one further woman who had antibodies against a private antigen. All multigravidas (N = 18) had previously given birth to an infant with NAITP and two of those infants had experienced severe bleeding. Two fetuses were negative for the offending antigen. The median and mean platelet count at first cordocentesis was 26 and 75 x 10(9)/l respectively (range 3-276). A total of 46 cordocentesis were carried out, of which 37 were followed by platelet transfusions. Bleeding complications were not observed. IVIG was administered to eight mothers and two fetuses responded. Nine infants were delivered by caesarean section (CS) and 10 vaginally at a mean gestational age of 37 weeks (range 34-41). The median and mean platelet count at birth was 141.5 and 140 x 10(9)/l, respectively (range 36-314). Ultrasound examination, both ante- and postnatally, revealed no intracranial haemorrhages. There was one procedure related neonatal death and one infant suffered from convulsions in the neonatal period due to a sinus thrombosis, possibly related to the platelet transfusions. CONCLUSIONS When obstetric history is taken into account cordocentesis in NAITP can be postponed. Safety recommendations described in this study allow cordocentesis without bleeding complications. However, our study does not support routine cordocentesis in patients with a history of NAITP. Both the risks of cordocentesis, and the lack of prospective data on the magnitude of the risk of intrauterine or peripartal bleeding, should be considered.
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Affiliation(s)
- H H Kanhai
- Department of Obstetrics, University Hospital Leiden, the Netherlands
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Beckers EA, Porcelijn L, Ligthart P, Vermey H, Von dem Borne AE, Overbeeke MA, van Rhenen DJ. The RoHar antigenic complex is associated with a limited number of D epitopes and alloanti-D production: a study of three unrelated persons and their families. Transfusion 1996; 36:104-8. [PMID: 8614957 DOI: 10.1046/j.1537-2995.1996.36296181919.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND the RoHar antigenic complex has been characterized serologically by difficulties in D typing, weak e expression, lack of G antigen, presence of Rh33, a low-frequency Rh antigen, and, more recently, a second low-frequency antigen, FPTT. Allocation to one of the partial D catagories was not considered because of the unuaual reactions of RoHar cells and because anti-D production was not observed in RoHar persons. STUDY DESIGN AND METHODS Three unrelated RoHar donors and their families were studied in detail with special emphasis on D epitope mapping, e and G typing, and screening for antibodies. RESULTS Only D epitopes 5 and 6/7 were demonstrable, and D epitopes 1, 2, 3, 4, 8, and 9 seem to be absent in the RoHar complex. In one individual, the presence of alloanti-D with limited specificity, not reacting with RoHar red cells of other individuals, was found 6 months after a second D+ pregnancy. CONCLUSION The finding of alloanti-D in an RoHar r person supports the concept that the D characteristic of this phenotype is a partial D antigen, which is consistent with the presence of the limited number of D epitopes found in epitope mapping. As has been suggested for other partial D antigens, RoHar individuals should be regarded as D- for the receipt of blood, and pregnant RoHar women who have had D+ pregnancies should receive anti-D prophylaxis.
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Affiliation(s)
- E A Beckers
- Red Cross Blood Bank and the Department of Hematology, University Hospital, Rotterdam, the Netherlands
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Overbeeke MA, Van Rhenen DJ, Ligthart PC, Vermey J, de Ruiter JA, Kruit GV, Langendam M, Porcelijn L, von dem Borne AE. Reactions of anti-D monoclonal antibodies with rhesus D variant cells. Transfus Clin Biol 1996; 3:397-9. [PMID: 9018797 DOI: 10.1016/s1246-7820(96)80052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M A Overbeeke
- Central Laboratory, The Netherlands Red Cross Blood transfusion Service, Amsterdam, The Netherlands
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Overbeeke MA, Kooyman PJ, Porcelijn L, von dem Borne AE. Assessment of monoclonal antibodies by the monocyte-mediated ADCC assay. Transfus Clin Biol 1996; 3:473-4. [PMID: 9018810 DOI: 10.1016/s1246-7820(96)80065-6] [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] [Indexed: 02/03/2023]
Affiliation(s)
- M A Overbeeke
- Central Laboratory, The Netherlands Red Cross Blood Transfusion Service, Amsterdam, The Netherlands
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35
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Noris P, Simsek S, de Bruijne-Admiraal LG, Porcelijn L, Huiskes E, van der Vlist GJ, van Leeuwen EF, van der Schoot CE, von dem Borne AE. Max(a), a new low-frequency platelet-specific antigen localized on glycoprotein IIb, is associated with neonatal alloimmune thrombocytopenia. Blood 1995; 86:1019-26. [PMID: 7620155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We have identified a new platelet-specific alloantigen, Max(a), responsible for a typical case of neonatal alloimmune thrombocytopenic purpura. The maternal serum reacted strongly with paternal platelets in the platelet immunofluorescence test, whereas platelet alloantigen typing showed that no known human platelet antigen (HPA)-system was involved. In the monoclonal antibody (MoAb)-specific immobilization of platelet antigens (MAIPA) assay, the new antigen was located on the platelet membrane glycoprotein (GP) IIb-IIIa complex, but immunoprecipitation and immunoblot experiments to further localize the antigen failed. However, in the MAIPA assay, the binding of the anti-Max(a) antibodies from the maternal serum was blocked by two anti-GPIIb MoAbs. Thus, the antigen appeared to be located on GPIIb. Analysis of the family lead to the identification of six additional Max(a+) individuals. Three of these six individuals and the father were tested in the platelet aggregation test and were found to be normal. In the analysis of normal donors, three of 500 were typed positive for the new platelet-specific antigen, indicating a phenotype frequency of 0.6% in the normal population. Platelet RNA was isolated from the newborn's Max(a)+ father and from a healthy donor phenotyped as Max(a-), reverse-transcribed, and the entire GPIIb coding region was amplified by polymerase chain reaction. Subsequent nucleotide sequence analysis showed a single G-->A substitution at position 2,603, predicting a valine-->methionine amino acid substitution at position 837 of the mature glycoprotein. This mutation abolished a BsiYI restriction site at the cDNA level and a BstNI restriction site at genomic DNA level, respectively. The genetic association between the new antigen and this point mutation was confirmed by allele-specific restriction analysis on cDNA and on genomic DNA, as well as by allele-specific primer amplification on genomic DNA. The new mutation is 19 bp upstream of the mutation underlying the HPA-3 system. Therefore, we also evaluated the association between Mas and the HPA-3 polymorphism. So far, all Max(a+) individuals were also found to be HPA-3b, whereas 50 HPA-3a individuals were all Max(a-). This may indicate that Max(a) is a variant of the HPA-3 allele.
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Affiliation(s)
- P Noris
- University of Pavia, IRCCS, Polyclinic S. Matteo, Italy
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Porcelijn L, Maat-Kievit JA, van Haeringen A. [Dysmaturity as symptom of the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome]. Tijdschr Kindergeneeskd 1993; 61:96-9. [PMID: 8211943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Low birthweight as a symptom of the ectrodactyly ectodermal dysplasia clefting (EEC) syndrome is described before by Annerén. By presenting two patients (father and son) we give a brief review of the major and minor symptoms. We would like to add low birthweight as a minor symptom.
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Affiliation(s)
- L Porcelijn
- Afd. Neonatologie, Academisch Ziekenhuis Leiden
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