Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management

Peterson, Julie A.; McFarland, Janice G.; Curtis, Brian R.; Aster, Richard H.

doi:10.1111/bjh.12235

Cited by 156 publications

(177 citation statements)

References 130 publications

Supporting

Mentioning

144

Contrasting

Unclassified

Order By: Relevance

“…Characteristic findings include distinctive facial features, short stature, chest deformity, and congenital heart disease, which may not be apparent during the first months of life and require a high index of suspicion during follow-up [5,6]. It is an autosomal dominant disorder with complete penetrance but variable expressivity [3]. Mutations in PTPN11 occur in 50% of patients, SOS1 in 13%, RAF in 3-17%, and KRAS in less than 5% [7].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prolonged thrombocytopenia in a child with severe neonatal alloimmune reaction and Noonan syndrome

et al. 2015

View full text Add to dashboard Cite

Fetomaternal alloimmune thrombocytopenia (FMAIT) caused by maternal antibodies is the leading cause of severe neonatal thrombocytopenia. A 1-month-old Caucasian girl was referred to our Hematology Clinic for persistent thrombocytopenia diagnosed after a bleeding episode. Diagnostic tests suggested FMAIT. Mild thrombocytopenia persisted for 18 months, and subsequent findings of dysmorphic facies, short stature and mild pulmonary stenosis led to the hypothesis of Noonan syndrome (NS), which was confirmed by genetic test. Other hematological abnormalities were excluded and she had no further bleeding episodes. This case illustrates the possibility of different diagnoses with the same clinical manifestations. The persistence of thrombocytopenia longer than expected associated with typical physical features led to the diagnosis of NS.

show abstract

Section: Resultsmentioning

confidence: 99%

“…When ICH is absent, the prognosis is usually favorable and the platelet count typically recovers to normal values within 8 to 10 days of life [1,2]. For reasons not well understood, a low count sometimes persists for longer periods of time, occasionally for several months [3].…”

Section: Introductionmentioning

confidence: 99%

Prolonged thrombocytopenia in a child with severe neonatal alloimmune reaction and Noonan syndrome

et al. 2015

View full text Add to dashboard Cite

show abstract

“…In Caucasians, more than 75% of FNAIT cases are induced by alloantibodies against human platelet antigen-1a (HPA-1a), 3,4 whereas the most common antibodies causing FNAIT in Japanese are anti-HPA-4b alloantibodies. 5 However, to date, this alloantibody specificity has not been found in Taiwan or China.…”

mentioning

confidence: 99%

Fetal/neonatal alloimmune thrombocytopenia due to anti‐CD36 antibodies: antibody evaluations by CD36‐transfected cell lines

Lin

Lee

et al. 2017

Transfusion

View full text Add to dashboard Cite

BACKGROUND: Isoantibodies against CD36 (platelet glycoprotein 4), developed in Type I CD36-deficient mothers are frequently reported as the cause of fetal/ neonatal alloimmune thrombocytopenia in the Asian population. Therefore, further detailed characterization of anti-CD36-mediated fetal/neonatal alloimmune thrombocytopenia is warranted. Here, we report the characterization of a patient with fetal/neonatal alloimmune thrombocytopenia in a Taiwanese family caused by anti-CD36 isoantibodies using a novel antigen-capture method. STUDY DESIGN AND METHODS:Platelets and monocytes were analyzed for CD36 expression by flow cytometry. Sequencing analysis of the CD36 gene was performed to identify the mutation underlying the CD36 deficiency. Stable transfected human embryonic kidney HEK293 cells expressing recombinant CD36 were established. These cells were used for the characterization of anti-CD36 isoantibodies by flow cytometry, immunoprecipitation, and antigen-capture assay. RESULTS:Flow cytometry analysis revealed a total absence of CD36 on both platelets and monocytes of the mother (Type I CD36-deficient) caused by heterozygous deletions of the CD36 gene (332_333delCA and c.1254 1 6_1254 1 11delTATTTG). Analysis of maternal serum with CD36-transfected HEK293 cells by flow cytometry, immunoprecipitation, and antigen-capture assay demonstrated the presence of anti-CD36 isoantibodies in maternal serum. Interestingly, this antibody could not be detected by the monoclonal antibody immobilization of platelet antigens assay when anti-CD36 monoclonal antibody (clone FA6-152) was used as the capture antibody.CONCLUSION: This case reemphasizes the role of anti-CD36 isoantibodies on the pathomechanism of fetal/ neonatal alloimmune thrombocytopenia. The fact that the monoclonal antibody immobilization of platelet antigens assay does not seem to be reliable for the identification of all anti-CD36 antibodies indicates that screening of anti-CD36 isoantibodies by a monoclonal antibody-independent method, as presented here, should be considered. Fetal/neonatal alloimmune thrombocytopenia (FNAIT), which occurs in from 1 of 800 to 1 of 1000 live births, is the most common cause of severe thrombocytopenia and intracranial hemorrhage in the fetus and in term newborns.1,2 FNAIT is caused by maternal antibodies, which recognize paternalderived alloantigens on fetal platelets, leading to platelet destruction. In Caucasians, more than 75% of FNAIT cases are induced by alloantibodies against human platelet antigen-1a (HPA-1a), 3,4 whereas the most common antibodies causing FNAIT in Japanese are anti-HPA-4b alloantibodies. The clinical importance of anti-CD36 isoantibodies in the development of FNAIT has been reported in different populations.9-13 Currently, the antigen-capture assay represents the gold standard for detecting platelet antibodies. 14 With this assay, platelet antigens captured by mouse monoclonal antibody are used as the target for platelet antibodies. Unfortunately, this approach does not seem to be reliable for the identi...

show abstract

“…The most frequently involved systems are HPA-1 and HPA-5, however, many other systems are involved. In the Caucasian population, the incidence of Fontal /Neonatal alloimmune thrombocytopenia (FNAIT) due to HPA-1a antigen is 1/1000 to 1500 live births [3,9]. The consequences of this immunization are not negligible.…”

Section: Discussionmentioning

confidence: 99%

Hpa-1(Human Platelet Antigen-1) Antigens in the Ivorian Population (West Africa)

Siransy¹,

Kouacou²,

Adou³

et al. 2017

ICPJL

View full text Add to dashboard Cite

The knowledge of antigens of erythrocyte blood groups enabled better transfusion management with a reduction in transfusion accidents. In recent years, progress has been made in the discovery and characterization of platelet antigens and the search for antiplatelet antibodies which also improve the management of patients in neonatology, transfusion therapy and organ transplantation. Unfortunately in Africa, few studies on the distribution of the frequency of platelet antigens are available. Given limited resources, our work aims to have a distribution of the frequency of platelet antigens of the HPA-1 system in the population in the Ivory Coast. The phenotyping of the antigens of the HPA-1 system was carried out on each tube of citrated blood collected by the MAIPA method (Monoclonal Antibody-Specific Immobilization Platelet Antigen). 184 blood donors with a male predominance were included and the results obtained during our work report a predominance of HPA-1a antigens with 99.46% versus 0.54% for HPA-1b antigens. To the best of our knowledge, there are no data available in Ivory Coast .Therefore, this work will allow us to establish a distribution of the platelet antigen polymorphism of the HPA-1 system of the Ivorian population and to demonstrate the need to implement measures to control the prevalence of immunizations related to platelets.

show abstract

Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management

Cited by 156 publications

References 130 publications

Prolonged thrombocytopenia in a child with severe neonatal alloimmune reaction and Noonan syndrome

Prolonged thrombocytopenia in a child with severe neonatal alloimmune reaction and Noonan syndrome

Fetal/neonatal alloimmune thrombocytopenia due to anti‐CD36 antibodies: antibody evaluations by CD36‐transfected cell lines

Hpa-1(Human Platelet Antigen-1) Antigens in the Ivorian Population (West Africa)

Contact Info

Product

Resources

About