Postnatal treatment for children with fetal and neonatal alloimmune thrombocytopenia: a multicentre, retrospective, cohort study

Vos, Thijs de; Winkelhorst, Dian; Árnadóttir, Valgerdur; Bom, Johanna G. van der; Surís, Carme Canals; Caram‐Deelder, Camila; Deschmann, Emöke; Haysom, Helen E; Hverven, Hem Birgit C; Krivec, Jana Lozar; McQuilten, Zoe; Muñiz‐Díaz, Eduardo; Nogués, Núria; Oepkes, Dick; Porcelijn, Leendert; Schoot, C. Ellen van der; Saxonhouse, Matthew A.; Sola‐Visner, Martha; Tiblad, Eleonor; Tiller, Heidi; Wood, Erica M.; Young, V R; Železnik, Mojca; Haas, Masja de; Lopriore, Enrico

doi:10.1016/s2352-3026(22)00243-5

Cited by 3 publications

(1 citation statement)

References 34 publications

(40 reference statements)

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“…79 An international web-based registry recently reported extreme thrombocytopenia (platelet count <10×10 9 /L) in 24% of neonates with FNAIT, but also identified considerable variation in practices for post-natal FNAIT treatments. 80 This registry provided evidence that platelet count increments were higher following HPA-matched transfusions compared to HPA-unmatched transfusions, although the effects of higher platelet increments on the risk of bleeding were less clear. 80…”

Section: Genetic Thrombocytopeniamentioning

confidence: 99%

How I diagnose and treat neonatal thrombocytopenia

Stanworth

Mumford

2023

Blood

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Neonatal thrombocytopenia defined as the presence of a circulating platelet count <150x109/L is a common abnormality in babies admitted to Neonatal Intensive Care Units. Thrombocytopenia that is typically mild and self-limiting often accompanies neonatal stress in scenarios such as premature delivery or intrauterine growth restriction. However, the differential diagnosis of neonatal thrombocytopenia is wide and includes potential life-threatening disorders such as bacterial sepsis, viral infection and necrotizing enterocolitis. Distinguishing these causes of thrombocytopenia from entities such as genetic thrombocytopenia and fetal and neonatal alloimmune thrombocytopenia is critical for the accurate quantitation of significant adverse events such as intracranial bleeding and for the selection of treatments such as platelet transfusion. In this review, we focus on common differential diagnoses of neonatal thrombocytopenia and highlight how the landscape of diagnosis and management is changing with recent advances in genomic technology and the completion of pivotal clinical trials of platelet transfusion practice. Increasing evidence highlights the need for judicious and restrictive use of platelet transfusions in neonates.

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Section: Genetic Thrombocytopeniamentioning

confidence: 99%

How I diagnose and treat neonatal thrombocytopenia

Stanworth

Mumford

2023

Blood

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Management der fetalen und neonatalen Alloimmunthrombozytopenie

2023

Neonatologie Scan

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In vitro Generated Megakaryocytes for the Detection of Human Platelet Antigen-Specific Alloantibodies

Uzun,

Lucic,

Marini

et al. 2024

Transfus Med Hemother

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Introduction: Serologic characterization of antihuman platelet antigen (HPA) alloantibodies is crucial in fetal neonatal alloimmune thrombocytopenia. The gold standard MAIPA assay requires fresh platelets from HPA-genotyped donors, which is challenging for some laboratories. Megakaryocytes express HPA epitopes and offer an alternative source for detecting anti-HPA antibodies. The objective of this study was to assess the efficacy of a novel assay called monoclonal antibody immobilization of megakaryocyte antigens (MAIMA) for detecting anti-HPA antibodies. Methods: CD34+ cells from buffy coats were differentiated into megakaryocytes in vitro. The performance of the MAIMA assay was evaluated using WHO reference reagents for HPA-1a, HPA-3a, and HPA-5b, along with sera samples from patients who had well-characterized anti-HPA antibodies. Results: The WHO anti-HPA-1a reference reagent showed similar binding to megakaryocytes and platelets in MAIMA and MAIPA, respectively. On the other hand, optical density (OD) values for the WHO anti-HPA-3a reference reagent were lower in MAIMA than in MAIPA. Anti-HPA-5b antibodies were not detectable in MAIMA. Patients’ sera containing anti-HPA-1a antibodies were successfully detected in MAIMA in all clinical samples. Moreover, OD values in MAIPA and MAIMA showed high correlation (r = 0.96, p < 0.001). MAIMA was reactive for samples with anti-HPA-3a as well as anti-HPA-3b; however, OD values were lower compared to MAIPA. Interestingly, all patient samples with anti-HPA-5b antibodies were tested negative in MAIMA. Conclusion: In vitro generated megakaryocytes can be used to detect anti-HPA-1a alloantibodies. However, despite this potential, they may be less suitable for the detection of alloantibodies against other HPAs such as HPA-5b.

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Postnatal treatment for children with fetal and neonatal alloimmune thrombocytopenia: a multicentre, retrospective, cohort study

Cited by 3 publications

References 34 publications

How I diagnose and treat neonatal thrombocytopenia

How I diagnose and treat neonatal thrombocytopenia

Management der fetalen und neonatalen Alloimmunthrombozytopenie

In vitro Generated Megakaryocytes for the Detection of Human Platelet Antigen-Specific Alloantibodies

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