Abstract
Background
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by anti-HPA alloantibody, and anti-HPA-4b is the most common cause in Japanese. Anti-HPA-5b is frequently detected in pregnant women, but it is still controversial whether anti-HPA-5b causes severe FNAIT.
Case presentation
A Japanese woman with anti-HPA-4b and anti-HPA-5b alloantibodies delivered a baby with severe FNAIT who was both HPA-4b and HPA-5b incompatible. We carefully monitored the patient’s following three pregnancies (the second and the fourth siblings were HPA-4b incompatible and HPA-5b compatible; the third sibling was both HPA-4b and HPA-5b compatible). FNAIT was not observed in all three siblings, although a modest decrease in cord blood platelet count was observed in the HPA-4b incompatible siblings compared to the HPA-4b compatible sibling. Serial monitoring of anti-HPA titer showed that anti-HPA-4b markedly decreased in late pregnancy and recovered after delivery of the HPA-4b incompatible siblings, but these decreases were not observed during the mother’s pregnancy with the HPA-4b compatible sibling. In contrast, anti-HPA-5b remained at a high titer during pregnancy with all three siblings.
Conclusion
Our data indicate that dynamic changes of anti-HPA-4b occur during pregnancy and strongly suggest that anti-HPA-5b was mainly responsible for severe FNAIT in this case.
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Data availability
The authors declare that the data supporting the findings of this study are available within the article.
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Acknowledgements
This study was supported in part of a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology (Grant no: 22K08476) and from the Ministry of Health, Labor and Welfare (Grant no. 20FC1024) in Japan.
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Kiyokawa, T., Mimura, K., Nagamine, K. et al. FNAIT pathogenesis determined by serial analysis of three subsequent pregnancies of a woman with severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) with anti-HPA-4b and anti-HPA-5b alloantibodies in the first sibling. Int J Hematol 118, 146–150 (2023). https://doi.org/10.1007/s12185-023-03559-1
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DOI: https://doi.org/10.1007/s12185-023-03559-1