eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Clinical research

Identification and follow-up of pregnant women with platelet-type human platelet antigen (HPA)-1bb alloimmunized with fetal HPA-1a

Marzena Dębska, Małgorzata Uhrynowska, Katarzyna Guz, Izabella Kopeć, Elżbieta Lachert, Agnieszka Orzińska, Piotr Kretowicz, Jolanta Antoniewicz-Papis, Romuald Dębski, Magdalena Łętowska, Anne Husebekk, Ewa Brojer

Arch Med Sci 2018; 14, 5: 1041–1047
Online publish date: 2016/11/15
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Pregnant women negative for human platelet antigen 1a (HPA-1a) are at risk of alloimmunization with fetal HPA-1a antigen inherited from the father, and their offspring may develop fetal and neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to analyze the frequency of HPA-1a alloimmunization in pregnant Polish women, the feasibility of using maternal platelets for intrauterine transfusions in women subjected to diagnostic fetal blood sampling (FBS) and to discuss potential consequences of alloimmunization.

Material and methods
Fifteen thousand two hundred and four pregnant women were typed for HPA-1a; HPA-1a negative were screened for anti-HPA-1a. Alloimmunized women received specialist perinatology care; some of them were subjected to FBS, followed by transfusion of HPA-1a negative platelet concentrates (PC) prepared from maternal blood.

Three hundred seventy-three (2.5%) women were HPA-1a negative, and 32 (8.6%) tested positively for anti-HPA-1a. Antibodies were detected in 22 women during pregnancy. Diagnostic FBS followed by PC transfusion was performed in 14 woman, who were platelet donors for their 16 unborn babies. Blood donations were tolerated well by the patients, and also intrauterine platelet transfusions were uneventful. Pharmacotherapy with intravenous immunoglobulins was implemented in 11/22 patients.

HPA-1a negative women (ca. 2.5% of all pregnant patients) are at risk of alloimmunization with HPA-1a antigen and developing FNAIT. Alloimmunized women can be donors of platelets for their offspring providing removal of antibodies from PC. Owing to potential complications, special care should be taken if an alloimmunized woman was qualified as a blood or stem cell recipient.


HPA-1a cohort study, anti-human platelet antigen 1a antibodies, fetal/neonatal alloimmune thrombocytopenia, platelet transfusions

Husebekk A. Fetal/neonatal alloimmune thrombocytopenia (FNAIT). Vox Sang 2011; 101: 1-1.
Mueller-Eckhardt C, Kiefel V, Grubert A, et al. 348 cases of suspected neonatal alloimmune thrombocytopenia. Lancet 1989; 1: 363-6.
Peterson JA, McFarland JG, Curtis BR, Aster RH. Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management. Br J Haematol 2013; 161: 3-14.
Sachs UJ. Fetal/neonatal alloimmune thrombocytopenia. Thromb Res 2013; 131 Suppl 1: S42-6.
Uhrynowska M, Dębska M, Guz K, et al. Zapobieganie alloimmunologicznej małopłytkowości płodów/noworodków (AIMPN) w Polsce – program PREVFNAIT. Ginekol Pol 2015; 86: 62-6.
Dębska M. Feto-maternal alloimmune trombocytopenia. Post Nauk Med 2009; 8: 628-34.
Uhrynowska M. Małopłytkowości u kobiet ciężarnych i ich dzieci – spojrzenie immunohematologa. Post Nauk Med 2008; 12: 823-7.
Uhrynowska M, Niżnikowska-Marks M, Żupanska B. Neonatal and maternal thrombocytopenia: incidence and immune background. Eur J Haematol 2000; 64: 42-6.
Maslanka K, Guz K, Zupanska B. Antenatal screening of unselected pregnant women for HPA-1a antigen, antibody and alloimmune thrombocytopenia. Vox Sang 2003; 85: 326-7.
Killie MK, Kjeldsen-Kragh J, Randen I, Skogen B, Husebekk A. Evaluation of a new flow cytometric HPA-1a screening method – a rapid and reliable tool for HPA-1a screening of blood donors and pregnant women. Transfus Apher Sci 2004; 30: 89-92.
Ficko T, Galvani V, Rupreht R, Dovc T, Rozman P. Real-time PCR genotyping of human platelet alloantigens HPA-1, HPA-2, HPA-3 and HPA-5 is superior to the standard PCR-SSP method. Transf Med 2004; 14: 425-32.
Kiefel V, Santoso S, Weisheit M, Mueller-Eckhardt C. Monoclonal-antibody specific immobilization of platelet antigens (MAIPA) – a new tool for the identification of platelet-reactive antibodies. Blood 1987; 70: 1722-6.
Kjeldsen-Kragh J, Killie MK, Tomter G, et al. A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia. Blood 2007; 110: 833-9.
Łętowska M, Żupańska B. Współczesne poglądy na nie­które powikłania poprzetoczeniowe. Acta Haematol Pol 2009; 40: 407-23.
Hendrickson JE, Hillyer CD. Noninfectious serious hazards of transfusion. Anesth Analg 2009; 108: 759-69.
Menis M, Forshee RA, Anderson SA, et al. Posttransfusion purpura occurrence and potential risk factors among the inpatient US elderly, as recorded in large Medicare databases during 2011 through 2012. Transfusion 2015; 55: 284-95.
Roubinian NH, Leavitt AD. Shedding a little light on posttransfusion purpura. Transfusion 2015; 55: 232-4.
Engelfriet CP, Reesink HW, Lee K, et al. Detection of platelet-reactive antibodies in patients who are refractory to platelet transfusions, and the selection of compatible donors. Vox Sang 2003; 84: 73-88.
Pavenski K, Webert KE, Goldman M. Consequences of transfusion of platelet antibody: a case report and literature review. Transfusion 2008; 48: 1981-9.
Lucas G, Culliford S, Green F, et al. Recipient-derived HPA-1a antibodies: a cause of prolonged thrombocytopenia after unrelated donor stem cell transplantation. Transfusion 2010; 50: 334-9.
Overton TG, Duncan KR, Jolly M, Letsky E, Fisk NM. Serial aggressive platelet transfusion for fetal alloimmune thrombocytopenia: platelet dynamics and perinatal outcome. Am J Obster Gynecol 2002; 186: 826-31.
Berkowitz RL, Lesser ML, McFarland JG, et al. Antepartum treatment without early cordocentesis for standard-risk alloimmune thrombocytopenia: a randomized controlled trial. Obstet Gynecol 2007; 110: 249-55.
Paidas MJ, Berkowitz RL, Lynch L, et al. Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis. Am J Obstet Gynecol 1995; 172: 475-9.
Bakchoul T, Bassler D, Heckmann M, et al. Management of infants born with severe neonatal alloimmune thrombocytopenia: the role of platelet transfusions and intravenous immunoglobulin. Transfusion 2014; 54: 640-5.
Lee AI, Kaufman RM. Transfusion medicine and the pregnant patient. Hematol Oncol Clin North Am 2011; 25: 393-413.
te Pas AB, Lopriore E, van den Akker ESA, et al. Postnatal management of fetal and neonatal alloimmune thrombocytopenia: the role of matched platelet transfusion and IVIG. Eur J Pediatr 2007; 166: 1057-63.
Kamphuis MM, Oepkes D. Fetal and neonatal alloimmune thrombocytopenia: prenatal interventions. Prenatal Diagn 2011; 31: 712-9.
Giers G, Wenzel F, Stockschlader M, et al. Fetal alloimmune thrombocytopenia and maternal intravenous immunoglobulin infusion. Haematologica 2010; 95: 1921-6.
Kanhai HH, Porcelijn L, Engelfriet CP, et al. Management of alloimmune thrombocytopenia. Vox Sanguinis 2007; 93: 370-85.
Murphy MF, Bussel JB. Advances in the management of alloimmune thrombocytopenia. Br J Haematol 2007; 136: 366-78.
Rayment R, Brunskill SJ, Soothill PW, Roberts DJ, Bussel JB, Murphy MF. Antenatal interventions for fetomaternal alloimmune thrombocytopenia. Cochrane Database Syst Rev 2011; 5: CD004226.
van den Akker ES, Oepkes D. Fetal and neonatal alloimmune thrombocytopenia. Best Pract Res Clin Obstet Gynaecol 2008; 22: 3-14.
Tiller H, Kamphuis MM, Flodmark O, 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: pii: e002490.
Paridaans NP, Kamphuis MM, Taune Wikman A, et al. Low-dose versus standard-dose intravenous immunoglobulin to prevent fetal intracranial hemorrhage in fetal and neonatal alloimmune thrombocytopenia: a randomized trial. Fetal Diagn Ther 2015; 38: 147-53.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe