Investigations for fetal and neonatal alloimmune thrombocytopenia: communication from the SSC of the ISTH

Petermann, Rachel; Bakchoul, Tamam; Curtis, Brian R.; Mullier, François; Miyata, Shigeki; Arnold, Donald M.; Immunology, Subcommittee on Platelet

doi:10.1111/jth.14294

Cited by 17 publications

(15 citation statements)

References 30 publications

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“…Trombosit değeri 50.000/mm 3 'ün altında ise trombosit sayısı minimum 24 saatte bir ya da 6-8 saatte bir yakın takip edilmelidir. 11 NAIT tanısı alan yenidoğanın tedavisi, klinik duruma ve trombositopeninin ciddiyetine bağlıdır. İlk tedavi seçeneğinin olabildiğince çabuk trombosit transfüzyonu olması gerektiği konusunda bir düşünce birliği vardır.…”

Section: Resim 1 Karın öN Duvarında Sırtta Ve Göz çEvresinde Saptanan Yaygın Ekimozlarunclassified

“…İlk tedavi seçeneğinin olabildiğince çabuk trombosit transfüzyonu olması gerektiği konusunda bir düşünce birliği vardır. 11,12 NAIT düşünülen bebeklerde trombosit değerinin 30.000/mm 3 'ün altında olması durumunda olabiliyorsa HPA1a ve HPA5b negatif trombosit süspansiyonu ile transfüzyon uygulanmalıdır. 13 Eğer risk faktörü varsa (travmatik doğum), prematürite ya da ek hastalık mevcut ise trombosit sayısı 50.000/mm3 altında olduğunda trombosit süspansiyonu uygulanmalıdır.…”

Section: Resim 1 Karın öN Duvarında Sırtta Ve Göz çEvresinde Saptanan Yaygın Ekimozlarunclassified

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Neonatal Alloimmune Thrombocytopenia Detected After Traumatic Delivery: Case Report

KAya¹,

Tanrıverdi²

2021

FORBES

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Neonatal Alloimmune Thrombocytopenia (NAIT), a complication of maternal alloimmunization against fetal platelets, is the result of immune destruction of platelets due to maternal antibodies in the early period. The cause of thrombocytopenia here is by antibodies developed against human platelet antigens frequently inherited from the mother. The clinical manifestations of NAIT extend from asymptomatic to severe bleeding. Platelet suspension can be used in the setting of severe thrombocytopenia or life-threatening bleeding. High-dose intravenous immunoglobulin (IVIG) therapy is another treatment option. A case who had no clinical finding except diffuse ecchymoses after traumatic delivery, but was considered to have NAIT due to severe thrombocytopenia and was successfully treated with platelet suspension and IVIG is presented.

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Section: Resim 1 Karın öN Duvarında Sırtta Ve Göz çEvresinde Saptanan Yaygın Ekimozlarunclassified

Neonatal Alloimmune Thrombocytopenia Detected After Traumatic Delivery: Case Report

KAya¹,

Tanrıverdi²

2021

FORBES

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“…Serological testing for platelet-specific antibodies generally as a minimum includes panels of antigens on gpIIb/IIIa, gpIb/IX, gpIa/IIa and CD109, and additional targets for populations with Asian/ African origin. [4].…”

Section: Identification Of Glycoprotein-specific Antibodiesmentioning

confidence: 99%

“…In addition to guiding compatible platelets to the affected newborn, the correct diagnosis will be valuable to assess the risk of FNAIT in subsequent pregnancies. Recommendations for FNAIT investigations were made by the Scientific Subcommittee on Platelet Immunology by International Society of Thrombosis and Haemostasis in 2018 [4], and by Lieberman et al [5] on behalf of the International Collaboration for Transfusion Medicine Guidelines (ICTMG) in 2019.…”

Section: Introductionmentioning

confidence: 99%

Serological and molecular typing in platelet alloantibody investigations

Ahlén

2019

ISBT Science Series

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Alloimmunization against platelet antigens causes complications in transfusion settings as platelet transfusion refractoriness and post-transfusion purpura, as well as in pregnancy, causing fetal/neonatal alloimmune thrombocytopenia. Strategies for the laboratory investigations depend on a repertoire of serological and molecular assays and are often dependent on timing and objective. Technical improvements have led to a number of sophisticated methods for alloantigen typing and alloantibody identifications during the last decade; however, some traditional methods are still beneficial. The laboratory investigations should ensure that the causative antibody specificities are identified as soon as possible to support the correct diagnosis and guide the selection of compatible platelets if needed.

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“…FNAIT is an immune‐mediated platelet disorder and a significant cause of neonatal morbidity. Clinical criteria for FNAIT include either a nadir platelet count below 100 × 10 9 /L at birth or within 7 days after birth of the affected child and/or fetal intracranial hemorrhage, both without a clear alternative cause 2 . Even if there is an apparent cause, FNAIT should be strongly considered if the platelet count is <50,000 × 10 9 /L and especially <20,000 × 10 9 /L 3 .…”

Section: Introductionmentioning

confidence: 99%

HLA antibodies in fetal and neonatal alloimmune thrombocytopenia

et al. 2023

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Background Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by antibodies against human platelet antigens (HPA). However, in many cases that meet clinical criteria for the condition, maternal sera do not have HPA antibodies. In studies examining whether human leukocyte antigen (HLA) antibodies cause FNAIT, the results are limited and inconclusive. This study sought to examine whether clinically suspected FNAIT cases with absent maternal HPA antibodies had different HLA antibody strength and specificity compared to controls. Study Design and Methods A retrospective case–control study assessed class I HLA antibody strength and specificity in cases submitted for testing to Versiti, Wisconsin. There were 813 cases that met initial screening criteria, but written consent could only be obtained for 50. After review of medical records and expert panel review, 31 cases with clinical criteria of FNAIT and maternal HLA but not HPA antibodies were included. Each case was matched for maternal age, gestational age at delivery, parity, and race/ethnicity to two controls from unaffected pregnancies that had maternal serum HLA antibodies. Results FNAIT cases were found to have both significantly higher HLA antibody strength, measured by mean fluorescence index (MFI), and broader HLA antibody specificity at antigen epitope level, compared to matched controls (p < .001). p‐values remained significant after controlling for parity and gestational age at delivery. Discussion Additional studies are needed to further examine whether the strong HLA antibodies identified in HPA‐antibody‐negative cases directly cause neonatal thrombocytopenia and whether prenatal treatment may be warranted in select cases to prevent recurrence.

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Investigations for fetal and neonatal alloimmune thrombocytopenia: communication from the SSC of the ISTH

Cited by 17 publications

References 30 publications

Neonatal Alloimmune Thrombocytopenia Detected After Traumatic Delivery: Case Report

Neonatal Alloimmune Thrombocytopenia Detected After Traumatic Delivery: Case Report

Serological and molecular typing in platelet alloantibody investigations

HLA antibodies in fetal and neonatal alloimmune thrombocytopenia

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