IntroductionThe platelet membrane glycoprotein (GP) IIb-IIIa complex or ␣ IIb  3 belongs to the integrin family of heterodimeric adhesion receptors involved in cell-matrix and cell-cell interactions. 1 This complex can bind ligands containing the Arg-Gly-Asp (RGD) sequence, such as fibrinogen, von Willebrand factor, vitronectin, and fibronectin. It plays a major role in platelet aggregation by interacting with the C-terminal part of the ␥ chain of fibrinogen. 2,3 The genes coding for GP IIb and GP IIIa are highly polymorphic. Most of the human platelet alloantigen (HPA) systems described are carried by the GP IIb-IIIa complex, and most of them are localized on the GP IIIa subunit: , and one unclassified private antigen Oe a . [4][5][6][7][8][9][10][11] Only 2 of the platelet antigen systems, HPA-3 and -9, reside on GP IIb, 12,13 and the genetic origin of the Va a antigen remains to be determined. 14 These antigenic systems result from a single base-pair substitution with the exception of Oe a , which depends on an in-frame deletion of 3 bases. 11 Platelet alloantigen systems are involved in neonatal alloimmune thrombocytopenia (NAIT), posttransfusion purpura, and refractoriness to platelet transfusions. NAIT is characterized by the destruction of fetal or newborn platelets by a maternal antibody elicited by the maternofetal platelet antigen incompatibility. During the course of the severe thrombocytopenia in the fetus or the newborn, there is a risk of intracerebral hemorrhage leading to death or neurologic impairment. The incidence of NAIT has been shown to be 1 per 800 to 1000 live births. 15 Most NAIT in Caucasians involves HPA-1 16 or HPA-5 17 (GP Ia polymorphism 18 ) maternofetal incompatibilities.We describe here a case of severe NAIT due to a new alloantigen Duv aϩ localized on GP IIIa. The genetic determination revealed a single base-pair substitution, CϾT, at the GP IIIa complementary DNA (cDNA) position 517. This leads to a threonine/isoleucine dimorphism at position 140 of the mature GP IIIa. The Duv aϩ form of the GP IIb-IIIa complex expressed in Cos cells shows this polymorphism is responsible for the alloimmunization and the consequent NAIT. The Duv aϩ polymorphism that was localized in the RGD binding site of GP IIIa could affect the ␣ IIb  3 function. Because no individuals homozygous for Duv aϩ were available, stable cell lines expressing the Duv aϩ form of GP IIb-IIIa were produced to study a possible effect of the Duv aϩ substitution on integrin function.
Materials and methods
Case reportWe report a 30-year-old white woman (Duv), para 4, gravida 4, who gave birth to a full-term male child with a severe thrombocytopenia at birth (platelets 17 ϫ 10 9 /L) associated with minor bruises and petechiae. The child was otherwise healthy (Apgar score 9 of 10). He was treated with a total of 1.6 g/kg intravenous immunoglobulin G (IgG) over 24 hours. On day 3, the platelet count had increased to 139 ϫ 10 9 /L, and the outcome was favorable. Neonatal thrombocytopenia was not recorded in any of the siblin...