Transfusion Medicine Reviews
Volume 22, Issue 4 , Pages 255-267 , October 2008

Diagnosis and Management of Neonatal Alloimmune Thrombocytopenia

References 

  1. Kjeldsen-Kragh J, Killie MK, Tomter G, et al. A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia. Blood. 2007;110:833–839
  2. Williamson LM, Hackett G, Rennie J, et al. The natural history of fetomaternal alloimmunization to the platelet-specific antigen HPA-1a (PlA1, Zwa) as determined by antenatal screening. Blood. 1998;92:2280–2287
  3. Turner ML, Bessos H, Fagge T, et al. Prospective epidemiologic study of the outcome and cost-effectiveness of antenatal screening to detect neonatal alloimmune thrombocytopenia due to anti–HPA-1a. Transfusion. 2005;45:1945–1956
  4. Uhrynowska M, Niznikowska-Marks M, Zupanska B. Neonatal and maternal thrombocytopenia: Incidence and immune background. Eur J Haematol. 2000;64:42–46
  5. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993;329:1463–1466
  6. Blanchette VS, Johnson J, Rand M. The management of alloimmune neonatal thrombocytopenia. Baillieres Best Pract Res Clin.Haematol. 2000;13:365–390
  7. Andrew M, Kelton J. Neonatal thrombocytopenia. Clin Perinatol. 1984;11:359–391
  8. Hohlfeld P, Forestier F, Kaplan C, et al. Fetal thrombocytopenia: A retrospective survey of 5,194 fetal blood samplings. Blood. 1994;84:1851–1856
  9. Murphy MF, Verjee S, Greaves M. Inadequacies in the postnatal management of fetomaternal alloimmune thrombocytopenia (FMAIT). Br J Haematol. 1999;105:123–126
  10. Bussel JB, Zacharoulis S, Kramer K, et al. Clinical and diagnostic comparison of neonatal alloimmune thrombocytopenia to non-immune cases of thrombocytopenia. Pediatr Blood Cancer. 2005;45:176–183
  11. Mueller-Eckhardt C, Kiefel V, Grubert A, et al. 348 cases of suspected neonatal alloimmune thrombocytopenia. Lancet. 1989;1:363–366
  12. Spencer JA, Burrows RF. Feto-maternal alloimmune thrombocytopenia: A literature review and statistical analysis. Aust N Z J Obstet Gynaecol. 2001;41:45–55
  13. Bonacossa IA, Jocelyn LJ. Alloimmune thrombocytopenia of the newborn: Neurodevelopmental sequelae. Am J Perinatol. 1996;13:211–215
  14. Bussel JB, Zabusky MR, Berkowitz RL, et al. Fetal alloimmune thrombocytopenia. N Engl J Med. 1997;337:22–26
  15. Dale ST, Coleman LT. Neonatal alloimmune thrombocytopenia: Antenatal and postnatal imaging findings in the pediatric brain. AJNR Am J Neuroradiol. 2002;23:1457–1465
  16. Durand-Zaleski I, Schlegel N, Blum-Boisgard C, et al. Screening primiparous women and newborns for fetal/neonatal alloimmune thrombocytopenia: A prospective comparison of effectiveness and costs. Immune Thrombocytopenia Working Group. Am J Perinatol. 1996;13:423–431
  17. Gruel Y, Boizard B, Daffos F, et al. Determination of platelet antigens and glycoproteins in the human fetus. Blood. 1986;68:488–492
  18. Castro C, Martinez ED, Rodriguez RC, et al. CNS siderosis and Dandy-Walker variant after neonatal alloimmune thrombocytopenia. Pediatr Neurol. 2005;32:346–349
  19. Vergani P, Strobelt N, Locatelli A, et al. Clinical significance of fetal intracranial hemorrhage. Am J Obstet Gynecol. 1996;175:536–543
  20. Kaplan C. Alloimmune thrombocytopenia of the fetus and the newborn. Blood Rev. 2002;16:69–72
  21. Murphy MF, Bussel JB. Advances in the management of alloimmune thrombocytopenia. Br J Haematol. 2007;136:366–378
  22. Kaplan C, Daffos F, Forestier F, et al. Management of alloimmune thrombocytopenia: Antenatal diagnosis and in utero transfusion of maternal platelets. Blood. 1988;72:340–343
  23. Radder CM, Brand A, Kanhai HH. Will it ever be possible to balance the risk of intracranial haemorrhage in fetal or neonatal alloimmune thrombocytopenia against the risk of treatment strategies to prevent it?. Vox Sang. 2003;84:318–325
  24. Glade-Bender J, McFarland JG, Kaplan C, et al. Anti–HPA-3A induces severe neonatal alloimmune thrombocytopenia. J Pediatr. 2001;138:862–867
  25. Jaegtvik S, Husebekk A, Aune B, et al. Neonatal alloimmune thrombocytopenia due to anti–HPA 1a antibodies; the level of maternal antibodies predicts the severity of thrombocytopenia in the newborn. BJOG. 2000;107:691–694
  26. Killie MK, Husebekk A, Kaplan C, et al. Maternal human platelet antigen–1a antibody level correlates with the platelet count in the newborns: A retrospective study. Transfusion. 2007;47:55–58
  27. Maslanka K, Guz K, Zupanska B. Antenatal screening of unselected pregnant women for HPA-1a antigen, antibody and alloimmune thrombocytopenia. Vox Sang. 2003;85:326–327
  28. Bessos H, Turner M, Urbaniak SJ. Is there a relationship between anti–HPA-1a concentration and severity of neonatal alloimmune thrombocytopenia?. Immunohematol. 2005;21:102–109
  29. Ghevaert C, Campbell K, Walton J, et al. Management and outcome of 200 cases of fetomaternal alloimmune thrombocytopenia. Transfusion. 2007;47:901–910
  30. Allen D, Rigsby P, Bessos H, et al. Collaborative study to establish the first international standard for quantitation of anti–HPA-1a. Vox Sang. 2005;89:100–104
  31. Bertrand G, Martageix C, Jallu V, et al. Predictive value of sequential maternal anti–HPA-1a antibody concentrations for the severity of fetal alloimmune thrombocytopenia. J Thromb Haemost. 2006;4:628–637
  32. Kaplan C. Fetal/neonatal allo-immune thrombocytopenias: the unsolved questions. Transfus Clin Biol. 2005;12:131–134
  33. Fratellanza G, Fratellanza A, Paesano L, et al. Fetoneonatal alloimmune thrombocytopenia (FNAIT): Our experience. Transfus Apher Sci. 2006;35:111–117
  34. Smith JW, Kelton JG, Horsewood P, et al. Platelet specific alloantigens on the platelet glycoprotein Ia/IIa complex. Br J Haematol. 1989;72:534–538
  35. Duncan JR, Rosse WF. Alloantibody-induced platelet serotonin release is blocked by antibody to the platelet PLA1 antigen. Br J Haematol. 1986;64:331–338
  36. Furihata K, Nugent DJ, Bissonette A, et al. On the association of the platelet-specific alloantigen, Pena, with glycoprotein IIIa. Evidence for heterogeneity of glycoprotein IIIa. J Clin Invest. 1987;80:1624–1630
  37. van Leeuwen EF, Leeksma OC, Van Mourik JA, et al. Effect of the binding of anti-Zwa antibodies on platelet function. Vox Sang. 1984;47:280–289
  38. Burrows RF, Kelton JG. Incidentally detected thrombocytopenia in healthy mothers and their infants. N Engl J Med. 1988;319:142–145
  39. Porcelijn L, Folman CC, de HM, et al. Fetal and neonatal thrombopoietin levels in alloimmune thrombocytopenia. Pediatr Res. 2002;52:105–108
  40. Panzer S, Mayr WR, Eichelberger B. Light chain phenotypes of HLA antibodies in cases with suspected neonatal alloimmune thrombocytopenia. Vox Sang. 2005;89:261–264
  41. Thude H, Schorner U, Helfricht C, et al. Neonatal alloimmune thrombocytopenia caused by human leucocyte antigen–B27 antibody. Transfus Med. 2006;16:143–149
  42. Kelton JG, Smith JW, Horsewood P, et al. ABH antigens on human platelets: Expression on the glycosyl phosphatidylinositol–anchored protein CD109. J Lab Clin Med. 1998;132:142–148
  43. Ogasawara K, Ueki J, Takenaka M, et al. Study on the expression of ABH antigens on platelets. Blood. 1993;82:993–999
  44. Stockelberg D, Hou M, Rydberg L, et al. Evidence for an expression of blood group A antigen on platelet glycoproteins IV and V. Transfus Med. 1996;6:243–248
  45. Curtis BR, Fick A, Lochowicz AJ, et al. Neonatal alloimmune thrombocytopenia associated with maternal-fetal incompatibility for blood group B. Transfusion. 2008;48:358–364
  46. von dem Borne AE, Decary F. Nomenclature of platelet-specific antigens. Hum Immunol. 1990;29:1–2
  47. Metcalfe P, Watkins NA, Ouwehand WH, et al. Nomenclature of human platelet antigens. Vox Sang. 2003;85:240–245
  48. Newman PJ, Derbes RS, Aster RH. The human platelet alloantigens, PlA1 and PlA2, are associated with a leucine33/proline33 amino acid polymorphism in membrane glycoprotein IIIa, and are distinguishable by DNA typing. J Clin Invest. 1989;83:1778–1781
  49. Santoso S, Kiefel V, Richter IG, et al. A functional platelet fibrinogen receptor with a deletion in the cysteine-rich repeat region of the beta(3) integrin: The Oe(a) alloantigen in neonatal alloimmune thrombocytopenia. Blood. 2002;99:1205–1214
  50. Davoren A, Curtis BR, Aster RH, et al. Human platelet antigen–specific alloantibodies implicated in 1162 cases of neonatal alloimmune thrombocytopenia. Transfusion. 2004;44:1220–1225
  51. Wang R, Furihata K, McFarland JG, et al. An amino acid polymorphism within the RGD binding domain of platelet membrane glycoprotein IIIa is responsible for the formation of the Pena/Penb alloantigen system. J Clin Invest. 1992;90:2038–2043
  52. Berry JE, Murphy CM, Smith GA, et al. Detection of Gov system antibodies by MAIPA reveals an immunogenicity similar to the HPA-5 alloantigens. Br J Haematol. 2000;110:735–742
  53. L'Abbe D, Tremblay L, Goldman M, et al. Alloimmunization to platelet antigen HPA-1a (Zwa): Association with HLA-DRw52a is not 100%. Transfus Med. 1992;2:251
  54. Valentin N, Vergracht A, Bignon JD, et al. HLA-DRw52a is involved in alloimmunization against PL-A1 antigen. Hum Immunol. 1990;27:73–79
  55. Kaplan C, Porcelijn L, Vanlieferinghen P, et al. Anti–HPA-9bw (Maxa) fetomaternal alloimmunization, a clinically severe neonatal thrombocytopenia: difficulties in diagnosis and therapy and report on eight families. Transfusion. 2005;45:1799–1803
  56. Peterson JA, Balthazor SM, Curtis BR, et al. Maternal alloimmunization against the rare platelet-specific antigen HPA-9b (Max a) is an important cause of neonatal alloimmune thrombocytopenia. Transfusion. 2005;45:1487–1495
  57. Kelton JG, Smith JW, Horsewood P, et al. Gova/b alloantigen system on human platelets. Blood. 1990;75:2172–2176
  58. Smith JW, Hayward CP, Horsewood P, et al. Characterization and localization of the Gova/b alloantigens to the glycosylphosphatidylinositol-anchored protein CDw109 on human platelets. Blood. 1995;86:2807–2814
  59. Kjaer KM, Jaegtvik S, Husebekk A, et al. Human platelet antigen 1 (HPA 1) genotyping with 5' nuclease assay and sequence-specific primers reveals a single nucleotide deletion in intron 2 of the HPA 1a allele of platelet glycoprotein IIIa. Br J Haematol. 2002;117:405–408
  60. Smith JW, Hayward CP, Warkentin TE, et al. Investigation of human platelet alloantigens and glycoproteins using non-radioactive immunoprecipitation. J Immunol Methods. 1993;158:77–85
  61. Warner MN, Moore JC, Warkentin TE, et al. A prospective study of protein-specific assays used to investigate idiopathic thrombocytopenic purpura. Br J Haematol. 1999;104:442–447
  62. Bertrand G, Jallu V, Gouet M, et al. Quantification of human platelet antigen-1a antibodies with the monoclonal antibody immobilization of platelet antigens procedure. Transfusion. 2005;45:1319–1323
  63. Kiefel V, Santoso S, Weisheit M, et al. Monoclonal antibody–specific immobilization of platelet antigens (MAIPA): a new tool for the identification of platelet-reactive antibodies. Blood. 1987;70:1722–1726
  64. Garner SF, Smethurst PA, Merieux Y, et al. A rapid one-stage whole-blood HPA-1a phenotyping assay using a recombinant monoclonal IgG1 anti-HPA-1a. Br J Haematol. 2000;108:440–447
  65. Denomme GA, Waye JS, Burrows RF, et al. The prenatal identification of fetal compatibility in neonatal alloimmune thrombocytopenia using amniotic fluid and variable number of tandem repeat (VNTR) analysis. Br J Haematol. 1995;91:742–746
  66. Bussel JB, Berkowitz RL, McFarland JG, et al. Antenatal treatment of neonatal alloimmune thrombocytopenia. N Engl J Med. 1988;319:1374–1378
  67. Berkowitz RL, Bussel JB, McFarland JG. Alloimmune thrombocytopenia: State of the art 2006. Am J Obstet Gynecol. 2006;195:907–913
  68. Bussel JB, Berkowitz RL, Lynch L, et al. Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: A randomized trial of the addition of low-dose steroid to intravenous gamma-globulin. Am J Obstet Gynecol. 1996;174:1414–1423
  69. Berkowitz RL, Lesser ML, McFarland JG, et al. Antepartum treatment without early cordocentesis for standard-risk alloimmune thrombocytopenia: A randomized controlled trial. Obstet Gynecol. 2007;110:249–255
  70. Bussel JB, Eldor A, Kelton JG, et al. IGIV-C, a novel intravenous immunoglobulin: Evaluation of safety, efficacy, mechanisms of action, and impact on quality of life. Thromb Haemost. 2004;91:771–778
  71. Pierce LR, Jain N. Risks associated with the use of intravenous immunoglobulin. Transfus Med Rev. 2003;17:241–251
  72. Marie I, Maurey G, Herve F, et al. Intravenous immunoglobulin-associated arterial and venous thrombosis; report of a series and review of the literature. Br J Dermatol. 2006;155:714–721
  73. Bussel JB, McFarland JG, Berkowitz RL. Antenatal management of fetal alloimmune and autoimmune thrombocytopenia. Transfus Med Rev. 1990;4:149–162
  74. Kaplan C, Murphy MF, Kroll H, et al. Feto-maternal alloimmune thrombocytopenia: Antenatal therapy with IvIgG and steroids—More questions than answers. European Working Group on FMAIT. Br J Haematol. 1998;100:62–65
  75. Paidas MJ, Berkowitz RL, Lynch L, et al. Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis. Am J Obstet Gynecol. 1995;172:475–479
  76. Mackenzie F, Brennand J, Peterkin M, et al. Management of fetal alloimmune thrombocytopenia—A less invasive option?. J Obstet Gynaecol. 1999;19:119–121
  77. Berkowitz RL, Kolb EA, McFarland JG, et al. Parallel randomized trials of risk-based therapy for fetal alloimmune thrombocytopenia. Obstet Gynecol. 2006;107:91–96
  78. van den Akker ES, Oepkes D, Lopriore E, et al. Noninvasive antenatal management of fetal and neonatal alloimmune thrombocytopenia: Safe and effective. BJOG. 2007;114:469–473
  79. Radder CM, Brand A, Kanhai HH. A less invasive treatment strategy to prevent intracranial hemorrhage in fetal and neonatal alloimmune thrombocytopenia. Am J Obstet Gynecol. 2001;185:683–688
  80. Yinon Y, Spira M, Solomon O, et al. Antenatal noninvasive treatment of patients at risk for alloimmune thrombocytopenia without a history of intracranial hemorrhage. Am J Obstet Gynecol. 2006;195:1153–1157
  81. Letsky EA, Greaves M. Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force of the British Society for Haematology. Br J Haematol. 1996;95:21–26
  82. van den Akker E, Oepkes D, Brand A, et al. Vaginal delivery for fetuses at risk of alloimmune thrombocytopenia?. BJOG. 2006;113:781–783
  83. Rayment R, Brunskill SJ, Stanworth S, et al. Antenatal interventions for fetomaternal alloimmune thrombocytopenia. Cochrane Database Syst Rev. 2005;1:CD004226
  84. van den Akker ES, Oepkes D. Fetal and neonatal alloimmune thrombocytopenia. Best Pract Res Clin Obstet Gynaecol. 2008;22:3–14
  85. Killie MK, Kjeldsen-Kragh J, Husebekk A, et al. Cost-effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia. BJOG. 2007;114:588–595
  86. Mueller-Eckhardt C, Kiefel V, Grubert A. High-dose IgG treatment for neonatal alloimmune thrombocytopenia. Blut. 1989;59:145–146
  87. Allen D, Verjee S, Rees S, et al. Platelet transfusion in neonatal alloimmune thrombocytopenia. Blood. 2007;109:388–389
  88. Kiefel V, Bassler D, Kroll H, et al. Antigen-positive platelet transfusion in neonatal alloimmune thrombocytopenia (NAIT). Blood. 2006;107:3761–3763
  89. Rebulla P. Platelet transfusion trigger in difficult patients. Transfus Clin Biol. 2001;8:249–254

 D.M. Arnold holds a New Investigator Award from the Canadian Institutes of Health Research. J.G. Kelton is a Canada Research Chair.

PII: S0887-7963(08)00039-4

doi: 10.1016/j.tmrv.2008.05.003

Transfusion Medicine Reviews
Volume 22, Issue 4 , Pages 255-267 , October 2008

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