Fetal and Neonatal Alloimmune Thrombocytopenia
Fetal and neonatal alloimmune thrombocytopenia [FNAIT] is a rare but potentially devastating condition that occurs when mothers form alloantibodies to paternally inherited fetal platelet antigens (often members of a human platelet antigen group). Unlike hemolytic disease of the newborn and fetus due to maternal erythrocyte alloantibodies, FNAIT commonly occurs during a mother’s very first pregnancy and thus is not realized until the birth of an affected child. Affected fetuses and neonates can suffer from mucocutaneous bleeding, intracranial hemorrhage, and even death. These same anti-platelet alloantibodies can also cause post-transfusion purpura, a rare transfusion reaction that causes isolated, unexplained, and profound thrombocytopenia several days after a blood transfusion (usually after receiving a non-platelet blood product). Post-transfusion purpura also inexplicably involves the destruction of the recipient’s own native platelets and has a 5–10% mortality rate from bleeding complications.
KeywordsAlloimmune thrombocytopenia Neonate Fetus Post-transfusion purpura Human platelet antigens
- 4.Kjeldsen-Kragh J, Killie MK, Tomter G, Golebiowska E, Randen I, Hauge R, et al. A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia. Blood. 2007;110(3):833–9. https://doi.org/10.1182/blood-2006-08-040121.CrossRefPubMedGoogle Scholar
- 9.European Bioinformatics Institute. Immuno polymorphism database. Cambridge, United Kingdom. 2017. http://www.ebi.ac.uk/ipd/hpa/table1.html. Accessed 25 Aug 2017.
- 15.Santoso S, Wihadmadyatami H, Bakchoul T, Werth S, Al-Fakhri N, Bein G, et al. Antiendothelial alphavbeta3 antibodies are a major cause of intracranial bleeding in fetal/neonatal alloimmune thrombocytopenia. Arterioscler Thromb Vasc Biol. 2016;36(8):1517–24. https://doi.org/10.1161/ATVBAHA.116.307281. CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Tiller H, Kamphuis MM, Flodmark O, Papadogiannakis N, David AL, Sainio S, et al. Fetal intracranial haemorrhages caused by fetal and neonatal alloimmune thrombocytopenia: an observational cohort study of 43 cases from an international multicentre registry. BMJ Open. 2013;3(3):pii: e002490. https://doi.org/10.1136/bmjopen-2012-002490.CrossRefGoogle Scholar
- 20.Bussel JB, Berkowitz RL, Hung C, Kolb EA, Wissert M, Primiani A, et al. Intracranial hemorrhage in alloimmune thrombocytopenia: stratified management to prevent recurrence in the subsequent affected fetus. Am J Obstet Gynecol. 2010;203(2):135.e1–14. https://doi.org/10.1016/j.ajog.2010.03.011.CrossRefGoogle Scholar
- 21.Berkowitz RL, Kolb EA, McFarland JG, Wissert M, Primani A, Lesser M, et al. Parallel randomized trials of risk-based therapy for fetal alloimmune thrombocytopenia. Obstet Gynecol. 2006;107(1):91–6. https://doi.org/10.1097/01.AOG.0000192404.25780.68.CrossRefPubMedGoogle Scholar
- 23.Weng YJ, Husebekk A, Skogen B, Kjaer M, Lin LT, Burnouf T. Anti-human platelet antigen-1a immunoglobulin G preparation intended to prevent fetal and neonatal alloimmune thrombocytopenia. PLoS One. 2016;11(9):e0162973. https://doi.org/10.1371/journal.pone.0162973.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Shulman NR, Aster RH, Leitner A, Hiller MC. A new syndrome of post-transfusion immunologic purpura. J Clin Invest. 1960;1960(39):1028–31.Google Scholar
- 25.Shulman NR, Aster RH, Leitner A, Hiller MC. Immunoreactions involving platelets. V. Post-transfusion purpura due to a complement-fixing antibody against a genetically controlled platelet antigen. A proposed mechanism for thrombocytopenia and its relevance in “autoimmunity”. J Clin Invest. 1961;40(9):1597–620. https://doi.org/10.1172/JCI104383.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing Committee of the American Society for Apheresis: the seventh special issue. J Clin Apher. 2016;31(3):149–62. https://doi.org/10.1002/jca.21470.CrossRefPubMedGoogle Scholar
- 28.Williamson LM, Stainsby D, Jones H, Love E, Chapman CE, Navarrete C, et al. The impact of universal leukodepletion of the blood supply on hemovigilance reports of posttransfusion purpura and transfusion-associated graft-versus-host disease. Transfusion. 2007;47(8):1455–67. https://doi.org/10.1111/j.1537-2995.2007.01281.x.CrossRefPubMedGoogle Scholar