Fetal and neonatal alloimmune thrombocytopenia

Darko Zdravic; Issaka Yougbare; Brian Vadasz; Conglei Li; Alexandra H Marshall; Pingguo Chen; Jens Kjeldsen-Kragh; Heyu Ni

doi:10.1016/j.siny.2015.12.004

Fetal and neonatal alloimmune thrombocytopenia

Semin Fetal Neonatal Med. 2016 Feb;21(1):19-27. doi: 10.1016/j.siny.2015.12.004. Epub 2016 Jan 20.

Authors

Darko Zdravic¹, Issaka Yougbare², Brian Vadasz³, Conglei Li³, Alexandra H Marshall⁴, Pingguo Chen², Jens Kjeldsen-Kragh⁵, Heyu Ni⁶

Affiliations

¹ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Canadian Blood Services, Toronto, ON, Canada.
² Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Canadian Blood Services, Toronto, ON, Canada.
³ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.
⁴ Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.
⁵ Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Department of Clinical Immunology and Transfusion Medicine, University and Regional Laboratories Region Skåne, Lund, Sweden.
⁶ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Department of Laboratory Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Canadian Blood Services, Toronto, ON, Canada; Department of Clinical Immunology and Transfusion Medicine, University and Regional Laboratories Region Skåne, Lund, Sweden; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada. Electronic address: nih@smh.ca.

PMID: 26810319
DOI: 10.1016/j.siny.2015.12.004

Abstract

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is an alloimmune disorder resulting from platelet opsonization by maternal antibodies that destroy fetal platelets. The major risk of FNAIT is severe bleeding, particularly intracranial hemorrhage. Miscarriage has also been reported but the incidence requires further study. Analogous to adult autoimmune thrombocytopenia (ITP), the major target antigen in FNAIT is the platelet membrane glycoprotein (GP)IIbIIIa. FNAIT caused by antibodies against platelet GPIbα or other antigens has also been reported, but the reported incidence of the anti-GPIbα-mediated FNAIT is far lower than in ITP. To date, the maternal immune response to fetal platelet antigens is still not well understood and it is unclear why bleeding is more severe in FNAIT than in ITP. In this review, we introduce the pathogenesis of FNAIT, particularly those new discoveries from animal models, and discuss possible improvements for the diagnosis, therapy, and prevention of this devastating disease.

Keywords: Antibody-induced immune suppression; Fetal and neonatal alloimmune thrombocytopenia; Intraveneous immunoglobulin G; Platelets; β3 integrin and GPIbα.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Animals
Disease Models, Animal
Female
Humans
Infant, Newborn
Perinatal Care / methods
Pregnancy
Prenatal Diagnosis
Thrombocytopenia, Neonatal Alloimmune* / diagnosis
Thrombocytopenia, Neonatal Alloimmune* / etiology
Thrombocytopenia, Neonatal Alloimmune* / immunology
Thrombocytopenia, Neonatal Alloimmune* / therapy

Abstract

Publication types

MeSH terms

Grants and funding