期刊
INTERNATIONAL JOURNAL OF HEMATOLOGY
卷 118, 期 1, 页码 146-150出版社
SPRINGER JAPAN KK
DOI: 10.1007/s12185-023-03559-1
关键词
Fetal and neonatal alloimmune thrombocytopenia; Anti-HPA-4b alloantibody; Anti-HPA-5b alloantibody
类别
A Japanese woman with anti-HPA-4b and anti-HPA-5b alloantibodies gave birth to a baby with severe FNAIT. During subsequent pregnancies, significant decrease of anti-HPA-4b titer was observed in late pregnancy and recovered after delivery of HPA-4b incompatible siblings, while high titer of anti-HPA-5b was persistent throughout all three pregnancies. These findings suggest that anti-HPA-5b may be mainly responsible for severe FNAIT in this case.
BackgroundFetal 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 presentationA 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.ConclusionOur 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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