Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies
Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant’s father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopae...
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| creator | Wendel, Kristina Akkök, Çiğdem Akalin Kutzsche, Stefan |
| description | Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant’s father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum. Weak antibodies against HLA-B57 and HLA-B58 in sera from both twins supported NAIT as the most likely diagnosis. Platelet transfusion requirements of the twins lasted for 7 weeks. Transfusion of HLA-matched platelet concentrates was more efficacious to manage thrombocytopaenia compared with platelet concentrates from random donors. Platelet genotyping and determination of HLA antibody specificity are needed to select compatible platelet units to expedite safe recovery from thrombocytopaenia in NAIT. |
| doi_str_mv | 10.1136/bcr-2016-218269 |
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Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum. Weak antibodies against HLA-B57 and HLA-B58 in sera from both twins supported NAIT as the most likely diagnosis. Platelet transfusion requirements of the twins lasted for 7 weeks. Transfusion of HLA-matched platelet concentrates was more efficacious to manage thrombocytopaenia compared with platelet concentrates from random donors. Platelet genotyping and determination of HLA antibody specificity are needed to select compatible platelet units to expedite safe recovery from thrombocytopaenia in NAIT.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2016-218269</identifier><identifier>PMID: 28679510</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Accuracy ; Age ; Antibodies - blood ; Antigens ; Antigens, Human Platelet - blood ; Blood ; Blood platelets ; Blood Platelets - metabolism ; Case reports ; Data collection ; Europe (West) ; Female ; Flow cytometry ; Genotype ; HLA-B Antigens - blood ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Indian sub-continent ; Infant, Newborn ; Maternal-Fetal Exchange ; Neonate ; Newborn babies ; Platelet Transfusion ; Pregnancy ; Reminder of Important Clinical Lesson ; Thrombocytopenia, Neonatal Alloimmune - blood ; Thrombocytopenia, Neonatal Alloimmune - diagnosis ; Thrombocytopenia, Neonatal Alloimmune - etiology ; Thrombocytopenia, Neonatal Alloimmune - therapy ; Twins</subject><ispartof>BMJ case reports, 2017-07, Vol.2017, p.bcr-2016-218269</ispartof><rights>BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>Copyright: 2017 © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b3719-a8ba6f776743d167a0d71350ec9f20cf230f72b4c4acfdc9419c44bccbedbb1b3</citedby><cites>FETCH-LOGICAL-b3719-a8ba6f776743d167a0d71350ec9f20cf230f72b4c4acfdc9419c44bccbedbb1b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534834/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534834/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28679510$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wendel, Kristina</creatorcontrib><creatorcontrib>Akkök, Çiğdem Akalin</creatorcontrib><creatorcontrib>Kutzsche, Stefan</creatorcontrib><title>Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant’s father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum. Weak antibodies against HLA-B57 and HLA-B58 in sera from both twins supported NAIT as the most likely diagnosis. Platelet transfusion requirements of the twins lasted for 7 weeks. Transfusion of HLA-matched platelet concentrates was more efficacious to manage thrombocytopaenia compared with platelet concentrates from random donors. Platelet genotyping and determination of HLA antibody specificity are needed to select compatible platelet units to expedite safe recovery from thrombocytopaenia in NAIT.</description><subject>Accuracy</subject><subject>Age</subject><subject>Antibodies - blood</subject><subject>Antigens</subject><subject>Antigens, Human Platelet - blood</subject><subject>Blood</subject><subject>Blood platelets</subject><subject>Blood Platelets - metabolism</subject><subject>Case reports</subject><subject>Data collection</subject><subject>Europe (West)</subject><subject>Female</subject><subject>Flow cytometry</subject><subject>Genotype</subject><subject>HLA-B Antigens - blood</subject><subject>Humans</subject><subject>Immunoglobulins</subject><subject>Immunoglobulins, Intravenous</subject><subject>Indian sub-continent</subject><subject>Infant, Newborn</subject><subject>Maternal-Fetal Exchange</subject><subject>Neonate</subject><subject>Newborn babies</subject><subject>Platelet Transfusion</subject><subject>Pregnancy</subject><subject>Reminder of Important Clinical Lesson</subject><subject>Thrombocytopenia, Neonatal Alloimmune - blood</subject><subject>Thrombocytopenia, Neonatal Alloimmune - diagnosis</subject><subject>Thrombocytopenia, Neonatal Alloimmune - etiology</subject><subject>Thrombocytopenia, Neonatal Alloimmune - therapy</subject><subject>Twins</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkc9r2zAUx0XpaEva827D0EsZuNEvW9ZlEErbFNL10sFu4kmWFwXbSiW7Jf_9FJyVbpfpogf6vC_v6YPQZ4KvCWHlXJuQU0zKnJKKlvIInRFRiFxI_PP4Q32KLmLc4HQY4RVnJ-iUVqWQBcFn6PG79T0M0GbQtt513djbbFgH32lvdoPfgu0dZBCjNw4GW2dvblhnXSpDn7qWq0UG_eC0r52N5-hTA220F4d7hn7c3T7fLPPV0_3DzWKVayaIzKHSUDZClIKzmpQCcC0IK7A1sqHYNJThRlDNDQfT1EZyIg3n2hhta62JZjP0bcrdjrqztbH9EKBV2-A6CDvlwam_X3q3Vr_8qyoKxivGU8DVISD4l9HGQXUuGtu20Fs_RkVkGgtLKmlCL_9BN37c7z5RWFbp9xM1nygTfIzBNu_DEKz2tlSypfa21GQrdXz5uMM7_8dNAr5OgO42_037DUzOn0c</recordid><startdate>20170705</startdate><enddate>20170705</enddate><creator>Wendel, Kristina</creator><creator>Akkök, Çiğdem Akalin</creator><creator>Kutzsche, Stefan</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170705</creationdate><title>Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies</title><author>Wendel, Kristina ; Akkök, Çiğdem Akalin ; Kutzsche, Stefan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b3719-a8ba6f776743d167a0d71350ec9f20cf230f72b4c4acfdc9419c44bccbedbb1b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Accuracy</topic><topic>Age</topic><topic>Antibodies - blood</topic><topic>Antigens</topic><topic>Antigens, Human Platelet - blood</topic><topic>Blood</topic><topic>Blood platelets</topic><topic>Blood Platelets - metabolism</topic><topic>Case reports</topic><topic>Data collection</topic><topic>Europe (West)</topic><topic>Female</topic><topic>Flow cytometry</topic><topic>Genotype</topic><topic>HLA-B Antigens - blood</topic><topic>Humans</topic><topic>Immunoglobulins</topic><topic>Immunoglobulins, Intravenous</topic><topic>Indian sub-continent</topic><topic>Infant, Newborn</topic><topic>Maternal-Fetal Exchange</topic><topic>Neonate</topic><topic>Newborn babies</topic><topic>Platelet Transfusion</topic><topic>Pregnancy</topic><topic>Reminder of Important Clinical Lesson</topic><topic>Thrombocytopenia, Neonatal Alloimmune - blood</topic><topic>Thrombocytopenia, Neonatal Alloimmune - diagnosis</topic><topic>Thrombocytopenia, Neonatal Alloimmune - etiology</topic><topic>Thrombocytopenia, Neonatal Alloimmune - therapy</topic><topic>Twins</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wendel, Kristina</creatorcontrib><creatorcontrib>Akkök, Çiğdem Akalin</creatorcontrib><creatorcontrib>Kutzsche, Stefan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wendel, Kristina</au><au>Akkök, Çiğdem Akalin</au><au>Kutzsche, Stefan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2017-07-05</date><risdate>2017</risdate><volume>2017</volume><spage>bcr-2016-218269</spage><pages>bcr-2016-218269-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant’s father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum. Weak antibodies against HLA-B57 and HLA-B58 in sera from both twins supported NAIT as the most likely diagnosis. Platelet transfusion requirements of the twins lasted for 7 weeks. Transfusion of HLA-matched platelet concentrates was more efficacious to manage thrombocytopaenia compared with platelet concentrates from random donors. Platelet genotyping and determination of HLA antibody specificity are needed to select compatible platelet units to expedite safe recovery from thrombocytopaenia in NAIT.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>28679510</pmid><doi>10.1136/bcr-2016-218269</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Accuracy Age Antibodies - blood Antigens Antigens, Human Platelet - blood Blood Blood platelets Blood Platelets - metabolism Case reports Data collection Europe (West) Female Flow cytometry Genotype HLA-B Antigens - blood Humans Immunoglobulins Immunoglobulins, Intravenous Indian sub-continent Infant, Newborn Maternal-Fetal Exchange Neonate Newborn babies Platelet Transfusion Pregnancy Reminder of Important Clinical Lesson Thrombocytopenia, Neonatal Alloimmune - blood Thrombocytopenia, Neonatal Alloimmune - diagnosis Thrombocytopenia, Neonatal Alloimmune - etiology Thrombocytopenia, Neonatal Alloimmune - therapy Twins |
| title | Neonatal alloimmune thrombocytopaenia associated with maternal HLA antibodies |
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