Archives of Gynecology and Obstetrics

, Volume 282, Issue 5, pp 573–575

Fetal genotyping for platelets antigens: a precise tool for alloimmune thrombocytopenia: case report and literature review

  • Marcelo Luís Nomura
  • Egle Couto
  • Beatriz Moraes Martinelli
  • Maria Lourdes Barjas-Castro
  • Ricardo Barini
  • Renato Passini Júnior
  • Vagner Castro
Short Communication



Maternal–fetal alloimmune thrombocytopenia complicates about 0.1% of all pregnancies and is associated with major fetal and neonatal morbidity and mortality, especially spontaneous central nervous system bleeding leading to death and neurological handicaps. Successful prevention and treatment depend on the identification of at-risk possible carriers of anti-platelet antibodies.

Case report

We report a case of a mother with a previous child that developed neonatal hemorrhage; HPA-5b anti-platelet antibodies were detected post-natally. During the next pregnancy, fetal genotyping confirmed the presence of HPA-5b antigen; she was treated with weekly intravenous human immunoglobulin and oral prednisone. Pregnancy evolved without remarkable features and a full-term baby was delivered, with normal platelet counts.


Fetal alloimmune thrombocytopenia is a potentially lethal condition, but early detection and prevention lead to successful outcome in most cases.


Thrombocytopenia, neonatal alloimmune Antigens, human platelet Pregnancy Fetal diseases Immunization, passive 


  1. 1.
    van den Akker ES, Oepkes D (2008) Fetal and neonatal alloimmune thrombocytopenia. Best Pract Res 22(1):3–14CrossRefGoogle Scholar
  2. 2.
    Kaplan C (2002) Platelet alloimmunity: the fetal/neonatal alloimmune thrombocytopenia. Vox Sang 83:289–291PubMedGoogle Scholar
  3. 3.
    Garratty G, Arndt P (1995) Applications of flow cytofluorometry to transfusion science. Transfusion 35(2):157–178CrossRefPubMedGoogle Scholar
  4. 4.
    Kiefel V, Santoso S, Weisheit M, Mueller-Eckhardt C (1987) Monoclonal antibody-specific immobilization of platelet antigens (MAIPA): a new tool for the identification of platelet-reactive antibodies. Blood 70(6):1722–1726PubMedGoogle Scholar
  5. 5.
    Metcalfe P, Watkins NA, Ouwehand WH et al (2003) Nomenclature of human platelet antigens. Vox Sang 85(3):240–245CrossRefPubMedGoogle Scholar
  6. 6.
    Davoren A, Curtis BR, Aster RH, McFarland JG (2004) Human platelet antigen-specific alloantibodies implicated in 1162 cases of neonatal alloimmune thrombocytopenia. Transfusion 44(8):1220–1225CrossRefPubMedGoogle Scholar
  7. 7.
    Castro V, Origa AF, Annichino-Bizzacchi JM et al (1999) Frequencies of platelet-specific alloantigen systems 1–5 in three distinct ethnic groups in Brazil. Eur J Immunogenet 26(5):355–360CrossRefPubMedGoogle Scholar
  8. 8.
    Rozman P (2002) Platelet antigens: the role of human platelet alloantigens (HPA) in blood transfusion and transplantation. Transpl Immunol 10(2-3):81–165Google Scholar
  9. 9.
    Castro V, Kroll H, Origa AF et al (2007) A prospective study on the prevalence and risk factors for neonatal thrombocytopenia and platelet alloimmunization among 9332 unselected Brazilian newborns. Transfusion 47(1):59–66CrossRefPubMedGoogle Scholar
  10. 10.
    Mueller-Eckhardt C, Kiefel V, Grubert A et al (1989) 348 cases of suspected neonatal alloimmune thrombocytopenia. Lancet 1(8634):363–366CrossRefPubMedGoogle Scholar
  11. 11.
    Williamson LM, Hackett G, Rennie J et al (1998) The natural history of fetomaternal alloimmunization to the platelet- specific antigen HPA-1a (PlA1, Zwa) as determined by antenatal screening. Blood 92(7):2280–2287PubMedGoogle Scholar
  12. 12.
    Kaplan C (2009) Fetal, neonatal alloimmune thrombocytopenias. Transfus Clin Biol 16(2):214–217CrossRefPubMedGoogle Scholar
  13. 13.
    Bussel JB, Primiani A (2008) Fetal and neonatal alloimmune thrombocytopenia: progress and ongoing debates. Blood Rev 22(1):33–52CrossRefPubMedGoogle Scholar
  14. 14.
    Kaplan C (2008) Neonatal alloimmune thrombocytopenia. Haematologica 93(6):805–807CrossRefPubMedGoogle Scholar
  15. 15.
    Povoa AM, Ramalho C, Machado AP, Matias A, Montenegro N (2007) Congenital posthemorrhagic hydrocephalus: a case of fetomaternal alloimmune thrombocytopenia. Fetal Diagn Ther 22(5):321–324CrossRefPubMedGoogle Scholar
  16. 16.
    Arnold DM, Smith JW, Kelton JG (2008) Diagnosis and management of neonatal alloimmune thrombocytopenia. Transfus Med Rev 22(4):255–267CrossRefPubMedGoogle Scholar
  17. 17.
    Kjeldsen-Kragh J, Killie MK, Tomter G et al (2007) A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia. Blood 110(3):833–839CrossRefPubMedGoogle Scholar
  18. 18.
    Bussel JB, Sola-Visner M (2009) Current approaches to the evaluation and management of the fetus and neonate with immune thrombocytopenia. Semin Perinatol 33(1):35–42CrossRefPubMedGoogle Scholar
  19. 19.
    Killie MK, Husebekk A, Kjeldsen-Kragh J, Skogen B (2008) A prospective study of maternal anti-HPA 1a antibody level as a potential predictor of alloimmune thrombocytopenia in the newborn. Haematologica 93(6):870–877CrossRefPubMedGoogle Scholar
  20. 20.
    Rayment R, Brunskill SJ, Stanworth S, Soothill PW, Roberts DJ, Murphy MF (2009) Antenatal interventions for fetomaternal alloimmune thrombocytopenia. Cochrane Database of Syst Rev (3):CD004226.pub1Google Scholar
  21. 21.
    Berkowitz RL, Kolb EA, McFarland JG et al (2006) Parallel randomized trials of risk-based therapy for fetal alloimmune thrombocytopenia. Obstet Gynecol 107(1):91–96PubMedGoogle Scholar
  22. 22.
    Ringwald J, Schroth M, Faschingbauer F et al (2007) Intrauterine use of hyperconcentrated platelet concentrates collected with Trima Accel in a case of neonatal alloimmune thrombocytopenia. Transfusion 47(8):1488–1493CrossRefPubMedGoogle Scholar
  23. 23.
    Yinon Y, Spira M, Solomon O et al (2006) Antenatal noninvasive treatment of patients at risk for alloimmune thrombocytopenia without a history of intracranial hemorrhage. Am J Obstet Gynecol 195(4):1153–1157CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Marcelo Luís Nomura
    • 1
  • Egle Couto
    • 1
  • Beatriz Moraes Martinelli
    • 1
  • Maria Lourdes Barjas-Castro
    • 1
  • Ricardo Barini
    • 1
  • Renato Passini Júnior
    • 1
  • Vagner Castro
    • 1
  1. 1.Hematology and Hemotherapy Center, Centro de Atenção Integral à Saúde da Mulher (CAISM)Universidade Estadual de Campinas (Unicamp), Cidade UniversitáriaCampinasBrazil

Personalised recommendations